Pleural Effusion: Causes, Symptoms, Treatment

Sometimes referred to as ‘water on the lungs’, pleural effusion is a condition where the layers of the pleura outside your lungs have excess fluid build-up. 

The pleura are thin membranes that usually contain a small amount of fluid that lubricates and facilitates breathing and lines the inside of the chest cavity and your lungs. 

The excess fluid build-up can be either protein-rich (exudative) or protein-poor (transudative). These are the two categories that can help your doctor to find the cause of this condition. 

Symptoms

You may not experience the symptoms of pleural effusion at first or may experience mild symptoms. Sometimes you may not experience the symptoms at all. 

Symptoms of this condition depend on the amount of fluid build-up and how fast it builds. It also depends on the underlying condition which has caused the fluid build-up. You may experience:

• Pain or heaviness in the chest
• Shortness of breath or breathing issues
• Cough
• Malaise – a common feeling of discomfort or illness
• Fear of suffocation
• Fever
• Anxiety

You may experience orthopnea, a condition where you feel shortness of breath while lying down. When you have this, you will feel better when you sit up or stand. 

Problem in breathing, especially shortness of breath may make you feel more tired than usual as it may cause difficulty in sleeping at night.

Ensure you get medical help immediately when you experience such symptoms. 

Causes

When fluid leaks into the pleural space, it causes transudative pleural effusion. This is a result of excessive pressure in the blood vessels or a low blood protein count. The different causes of exudative effusion are blocked blood vessels or lymph vessels, infection, inflammation, injury to lungs, and tumors.

Common causes of exudative pleural effusion

• Pulmonary embolism
• Cancer
• Inflammatory disease
• Pneumonia
• Kidney disease

Common causes of transudative pleural effusions

• Pulmonary embolism
• Cirrhosis
• Post open heart surgery
• Heart failure

Uncommon causes of pleural effusion

• Asbestos pleural effusion 
• Meigs syndrome
• Rare chest and abdominal infections
• Autoimmune diseases
• Bleeding 
• Tuberculosis
• Ovarian hyperstimulation syndrome
• Chylothorax 

You may also suffer from this condition due to radiation therapy, abdominal surgery, and certain medications. It may also occur with several types of cancer including lymphoma, lung, and breast cancer. In some cases, the fluid collected itself can be cancerous.

Risk Factors

Men and women are at risk of developing pleural effusion due to the following factors:

• Surgery of abdomen, heart, or lungs
• Underwent organ transplant
• Radiation therapy
• Certain health conditions
• Chest injury
• Certain medications

There are also certain factors that may contribute to putting you at increased risk of pleural effusion:

• Any previous complaint of hypertension or any symptoms of high blood pressure
• Family history of asbestosis
• Smoking and alcohol consumption

Diagnosis

When you experience the symptoms of pleural effusion, ensure you visit the doctor’s clinic immediately and get medical attention. 

Your doctor will conduct a physical examination and may order a few tests to diagnose this condition. 

Following are the tests that your doctor may order:

• Thoracentesis: It is a process where the expert will draw the fluid from the pleura and pass it forward for analysis. The fluid is drawn with the help of a small needle. In the lab, the fluid is checked for cancer, protein levels, and infections. 
• Echocardiography: It is a heart-monitoring test that helps the expert to know if you have any heart condition that results in the fluid build-up. 
• Chest X-ray: A chest X-ray will help your doctor to identify the fluids creating pressure or the presence of any blockages. 
• Fluoroscopy: This imaging test helps provide real-time images with the help of X-ray imaging. 
• Ultrasound: An ultrasound can help detect the location of fluid build-up or inflammation. 
• Computed tomography (CT) scan: This imaging test combines computer technology and X-ray to create detailed images of your chest cavity from all sides. 
• Thoracoscopy: It is a surgical procedure where an endoscope – a thin and flexible instrument with a small camera is inserted into your chest. The doctor makes a small incision and passes an endoscope to take a closer look at the cause of this condition. The doctor may take a tissue sample for further analysis, most commonly called a biopsy.

Your doctor may also order a few blood tests like:

• Kidney and liver function blood tests
• Complete blood count (CBC) test

Treatment

Your treatment depends on the test results and the underlying cause of the pleural effusion. A minor pleural effusion may resolve on its own. 

Your doctor may prescribe diuretics and other heart failure medications if congestive heart failure is the reason for this condition. For malignant effusion or cancerous fluid build-up, your doctor may suggest radiation therapy, chemotherapy, or a drug is inserted within the chest. 

Thoracentesis may be done to remove extra fluid surrounding the lungs. It is done by inserting a hollow needle in the middle of your ribs into the pleural cavity.

Your doctor may use a sclerosing agent occasionally if this condition is uncontrollable or recurs due to cancer. A sclerosing agent is a type of drug that causes scarring purposefully. This drug is instilled into your pleural cavity via tube thoracostomy to create fibrosis of the pleura, also called pleural sclerosis.

Pleural sclerosis is 50 % successful in preventing the recurrence of pleural effusion. The expert will use sclerosing agents like tetracycline, talc, and doxycycline for pleural sclerosis.

Surgery for Pleural Effusion

If this condition cannot be managed through pleural sclerosis or drainage, your doctor may order surgery. 

Pleural effusion surgery can be done in 2 ways:

1: Thoracotomy A.K.A open thoracic surgery

For this surgery, your doctor may make a single incision of approximately 6 to 8 inches in your chest. Typically, doctors recommend open thoracic surgery when there is a presence of infection with pleural effusion. 

This surgery is performed to remove all the fibrous tissues and treat the infection present on the pleural space. After the surgery, the patient will require chest tubes for 2 days to 2 weeks approximately to get rid of fluid completely.

2: Video-assisted thoracoscopic surgery (VATS)

It is a minimally invasive surgery that is completed through 1 to 3 small cuts or incisions in your chest. 

This surgery can effectively manage pleural fluid build-ups that may develop again due to cancer or are difficult to drain. The surgeon may insert antibiotic or sterile talc at the time of surgery to prevent a recurrence. 

After the surgery, your doctor will carefully examine your condition to decide on a suitable treatment option for you. Your doctor may also discuss the benefits and possible risks from the suggested treatment. 

Lifestyle Changes

Your doctor will suggest a few lifestyle changes for pleural effusion that you must follow. Your doctor may suggest:

• Use a pillow: You can use a pillow to create pressure on your chest to decrease pain. You can also hold a pillow against your chest while taking a deep breath or coughing. 
• Avoid smoking: It’s not enough to avoid smoking, but also to avoid being around smokers. Also, protect yourself from other kinds of smoke. Smoking is dangerous for your lungs and can cause pneumonia. Smoking not only makes it harder for you to improve your lung health but also causes breathing issues. 
• Drink enough fluids and rest as much as you can: Fluids help to keep your air passage moist and get rid of germs and other irritants. Ask your doctor about your fluid drinking habits and a suitable amount. Rest as much as you can to help recover from your condition. 
• Try deep breathing and coughing: Deep breathing and coughing may decrease the risk of a lung infection. Take a deep breath and hold it for a few seconds and breath out. Once you breathe out, try coughing strongly. A deep breath can help open up your airways.

Apart from these lifestyle changes, your doctor may also suggest a few more that may be suitable for your particular condition. Ensure you follow it properly. In case you have any doubts or face any issues, visit the doctor’s clinic immediately.