An extraordinary buildup of fluid that surrounds the lung is known as a pleural effusion. And although your pleural effusion will need to be drained, your doctor will probably address the underlying medical problem that contributed to it because many different illnesses can trigger it. Your lungs' outermost layers and the interior of your rib cage are lined with a thin membrane called the pleura. The gap between both the layers of your pleura fills with fluid if you got a pleural effusion. The pleural space typically contains only a small amount of watery fluid, enabling your lungs to move freely inside your chest when you inhale or exhale. Viral infections, pneumonia, and heart problems are among the causes of pleural effusion that can be successfully treated or managed.

The extra fluid may be exudative or transudative, based on the source. These two classifications aid medical professionals in identifying the pleural effusion's underlying cause.

Transudative Pleural Effusions

It is a type of pleural effusion that has a very low protein content. The following are the most common causes of transudative pleural effusions:

·         Cardiac failure

·         Pulmonary embolism

·         Cirrhosis

·         Following open-heart surgery

Exudative Pleural Effusions

It is a pleural effusion with very high protein content. Exudative pleural effusions are often brought on by:

·         Pneumonia

·         Malignancy

·         Pulmonary embolism

·         Kidney illness 

Risk factors of effusion include:

·         Alcohol consumption and smoking

·         Any prior exposure to asbestos

·         Previous history of lung disease

·         Lung cancer

·         Alcohol abuse

·         Liver scarring

·         A chest injury

In developed nations, the incidence of pleural effusion is estimated to be 320 instances per 100,000 people, with various causes linked to the frequency of underlying disorders.

One study revealed that the most frequent trigger of unilateral pleural effusion is tuberculosis, the next is parapneumonic effusion, and most instances of those are at a younger age. The most frequent etiology of bilateral pleural effusion is heart failure.

Clinical symptoms depend upon the size of the pleural effusion. Perhaps you may not develop any symptoms if the size is small. When a pleural effusion is moderate or large in size or when there is additional irritation, you are more prone to having symptoms.

Some of the symptoms are as follows:

·         Breathing difficulties

·         Chest pain, especially while inhaling hard 

·         Fever

·         Cough

Your doctor will examine you physically and discuss your problems with you. They will tap on your lungs while using a stethoscope to listen. You may be advised to undergo imaging studies, such as:

X-ray chest

To determine whether you have a pleural effusion. On X-rays, airspace appears dark, while pleural effusions are seen as white. When a pleural effusion is suspected, more X-ray films may be taken while you lie on your side. These can demonstrate if the pleural fluid readily flows or not.

Ct scan of the chest

A picture of the complete chest, inside or out, is created by a computer after a rapid series of X-rays are taken using a CT scanner. Chest X-rays lack the level of information that CT scans do.

An ultrasound scan of the chest

A device will produce pictures of the interior of your body on your chest, which will appear on a visual display. Your physician could find the fluid using ultrasound so that they can then collect a specimen for testing.

Thoracentesis

Additionally, thoracentesis is a technique that your physician could do. A small amount of the fluid will be taken for testing. Doctors put a needle and a tube into the pleural area between your ribs to accomplish this.

The differential diagnosis of pleural effusion includes:

·         An empyema might imitate a pleural effusion

·         Congestive heart failure

·         Liver disease and cirrhosis

·         Chronic kidney disease

·         Continuous ambulatory peritoneal dialysis

·         Hypoproteinemia

·         Malignancy

·         Pneumonia

·         Tuberculosis

·         Pulmonary embolism

·         Mold infection

·         Pseudocyst in the pancreas

According to your doctor, only the illness that produced pleural effusion may have to be treated. For example, you would be prescribed medicines for pneumonia or pills for heart problems.

Significant, infected, or inflammatory pleural effusions frequently require clearance to help ease the pain and avoid further issues. Treatment methods for pleural effusions usually involve:

Medications

Pleural effusion brought on by heart problems or other medical conditions is treated with diuretics and other heart disease drugs. Chemo, radiation therapy, or a chest infusion of medicines may be used to treat a malignant effusion.

Procedure

Tube thoracostomy 

A therapeutic thoracentesis or tube thoracostomy may be used to empty a pleural effusion that creates respiratory difficulties.

Pleural sclerosis

A sclerosing substance may occasionally be injected into the pleural space using a tube thoracostomy to generate scarring of the pleura for individuals with pleural effusions which are unmanageable or recur owing to cancer despite drainage. In 50% of cases, pleural effusion can be stopped using sclerosing drugs such as talc, tetracycline, and doxycycline.

Video-Assisted thoracoscopic surgery

It is a surgical procedure requiring only one to three minor chest cuts. This method also referred to as thoracoscopic surgery, helps treat pleural effusions that are challenging to drain or that reoccur because they are malignant. To avoid a repeat of the fluid buildup, clean talc or an antimicrobial might be administered during the operation.

Open thoracic surgery

If an infection is present, a thoracotomy—performed thru a 6- to 8-inch incision in the chest—is advised for patients with pleural effusions. The infection is removed from the pleural cavity by performing a thoracotomy to eliminate all or most of the fibrous tissue. For two to three weeks following surgery, individuals will need chest tubes to continue to drain fluid.

The prognosis for developing a malignant pleural effusion is extremely bad, with a survival rate of four months and a normal survival of fewer than one year. Lung cancer is the most frequently related malignancy among men. Approximately one-third of individuals with pleural effusions pass away within a year of hospitalization, and many more pass away within a month.

Some lifestyle changes may be all you need to make to control your symptoms. These include:

·         Stop smoking at all costs, and if you want to quit, get assistance from smoking cessation clinics.

·         Learn good stress management techniques. Make regular hand washing a routine to free yourself from germs or viruses.

·         To reduce inflammation and discomfort, use medicine as directed by your doctor.

·         Get lots of sleep. Find the sleeping position that gives you the minimum amount of pain.

·         Green vegetables are an excellent source of beta-carotene, iron, potassium, calcium, and vitamins. Examples include bok choy, spinach, and kale. Due to their anti-inflammatory and antioxidant properties, these substances can assist in decreasing lung inflammation and improving general health.

Our clinical experts continually monitor the health and medical content posted on CURA4U, and we update our blogs and articles when new information becomes available. Last reviewed by Dr.Saad Zia on May 08, 2023.

References

https://www.pennmedicine.org/for-patients-and-visitors/patient-information/conditions-treated-a-to-z/pleural-effusion#:~:text=Definition,the%20lungs%20and%20chest%20cavity.

https://www.nejm.org/doi/full/10.1056/NEJMcp010731