Pleural Effusion

Pleural effusions are conditions that affect the tissue that covers the outside of the lungs and lines the inside of your chest cavity. The tissue is known as the pleura and the thin space between its two layers is call the pleural space. A small amount of fluid fills the pleural space, and when you breathe in and out, this fluid helps the layers of the pleura slide smoothly against each other. Injury, inflammation, or infection can cause blood or air to collect in the pleural space and cause pleural effusion. The pleura is the membrane that lines the thoracic i.e. chest cavity and covers the lungs.

It looks like a large sheet of tissue that wraps around the outside of the lungs and lines the inside of the chest cavity. A pleural effusion is sometimes refer to as “water on the lungs,” the accumulation of excess fluid between the layers of the pleura outside the lungs. The pleura are thin membranes that line the inside of the lungs and chest cavity and serve to lubricate and facilitate breathing. Normally, there is a little amount of fluid in the pleura.

Types of Pleural Effusion

You have heard your doctor uses the terms “transudative” and “exudative” to describe the two main types of pleural effusion.

1. Transudative.This transitional pleural effusion fluid is similar to the fluid you normally have in your pleural space. It is formed by the leakage of fluid into the normal pleura so This type rarely needs to be removed unless it is very large. The most common cause of this type is Heart failure.
2. Exudative. It is made up of excess fluid, protein, blood, and inflammatory cells. Sometimes bacteria that seep into the pleura through damaged blood vessels. Depending on its size and how inflamed it is, you may need to have it removed. These types of causes include pneumonia and lung cancer.

Causes

Pleural effusion occurs when fluid collects outside the lungs in the chest cavity.

Transudative pleural effusion occurs when increased pressure on the pleural and pleural vessels of various organs causes them to leak, resulting in the accumulation of protein-rich fluid. It often occurs with coronary heart disease or cirrhosis.

Exudative pleural effusion occurs when there is irritation, inflammation, or infection. This may result from excess fluid production, reduced drainage, or both.

Reliable sources of pleural effusion causes include:

1. Congestive heart failure
2. Cirrhosis or liver dysfunction
3. Pulmonary embolism is caused by a blood clot and blockage of the arteries in the lungs.
4. Complications arising from open heart surgery
5. Pneumonia
6. Acute kidney disease
7. Autoimmune diseases, i.e. lupus and rheumatoid arthritis
8. Use of certain medications, such as methotrexate, phenytoin, or amiodarone
9. Radiation therapy
10. Esophageal rupture
11. Ovarian hyperstimulation syndrome
12. Certain types of cancer, for example, lung cancer, and breast cancer
13. COVID-19

Other bit common causes include:

1. Tuberculosis
2. Autoimmune disease
3. Bleeding (due to chest trauma)
4. Chylothorax (due to trauma)
5. Rare chest and abdominal infections
6. Asbestos pleural effusion (due to asbestos exposure)
7. Magg’s syndrome (caused by a benign ovarian tumor)
8. Ovarian hyperstimulation syndrome

Symptoms of Pleural Effusion

Some patients with pleural effusion have no symptoms, with the condition discovered on a chest X-ray done for another reason. The patient may have symptoms unrelated to the disease or condition that caused the effusion. Symptoms of pleural effusion include:

1. Chest pain
2. Dry, nonproductive cough
3. Dyspnea (difficulty breathing, or shortness of breath)
4. Orthopnea (inability to breathe easily unless the person is sitting or standing upright)

Diagnosis

Tests commonly used to diagnose and diagnose pleural effusion include:

1. Chest x-ray
2. A CT scan of the chest
3. Chest ultrasound
4. Thoracentesis (biopsy, or a needle inserted between the ribs to remove a sample of fluid)
5. Pleural fluid analysis (examination of fluid removed from the pleural space)

When previous, less invasive tests do not diagnose pleural effusion, thoracoscopy may be perform. Thoracoscopy is a minimally invasive technique, also called video-assisted thoracoscopic surgery, or VATS, performed under general anesthesia that allows visual assessment of the pleura). But often, downstream treatment is combine with diagnosis in these cases.

How is pleural effusion treated?

1. Treatment for pleural effusion depends on the underlying condition and whether the effusion is causing severe respiratory symptoms, such as shortness of breath or difficulty breathing.
2. Diuretics and other heart failure medications are used to treat this disease caused by heart failure or other medical causes. Malignant effusions may also require treatment with chemotherapy, radiation therapy, or infusions of drugs into the chest.
3. A pleural effusion that is causing respiratory symptoms can be removed using therapeutic thoracentesis or through a chest tube (called a tube thoracostomy).
4. For patients with pleural effusions that are uncontrollable or recur despite drainage, a sclerosing agent (a type of drug that causes intentional scarring) is sometimes injected into the pleural cavity through a tube thoracostomy. So can be injected to cause fibrosis (excessive fibrous tissue). Pleural sclerosis.
5. Pleural sclerosis performed with sclerosing agents (such as talc, doxycycline, and tetracycline) is 50% successful in preventing the recurrence of pleural effusions.

Surgery

Pleural effusions that cannot be manage by drainage or pleural sclerosis may require surgical treatment.

Two types of surgery include:

Your surgeon will carefully evaluate you to determine the safest treatment option and discuss the potential risks and benefits of each treatment option.