The pleura are two thin, moist membranes around the lungs. They let your lungs expand and contract. The inner layer is attached to the lungs. The outer layer is attached to the ribs. Pleural effusion is a buildup of extra fluid in the space between the pleura. This can make it hard for the lungs to open all the way. This can make it hard to breathe.
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The cause is usually disease or injury. Pleural effusion may be watery (transudative) or thick (exudative).
The transudative type may be from:
- Heart failure or pericarditis
- Pulmonary embolism
- Kidney disease
- Liver disease
- Swelling of the pancreas
- A large shift in body fluids
The exudative type may be from:
- Lung infections, such as pneumonia
- Rheumatic disease, such as sarcoidosis
- Anti-inflammatory diseases, such as lupus
- Cancer, especially of the lung , breast , or lymph system
- Blood clots in the lung
Factors that may raise your risk are:
- Having the health problems above
- Taking certain medicines
- Chest injury
- Radiation therapy
Surgery, especially involving:
- Organ transplants
Some types of pleural effusion do not cause symptoms. Others may cause:
- Shortness of breath
- Shallow breathing
- Rapid heartbeat or breathing
- Chest pain
- Stomach pain
- Coughing up blood
- Weight loss
- Fever or chills
You will be asked about your symptoms and health history. A physical exam will be done. This may include listening to or tapping on your chest. Lung function tests will test how well you can move air in and out of your lungs.
Some blood tests will be done based on what the doctor thinks it causing the fluid.
Pictures may be taken to view your lungs. This can be done with:
Your doctor may take samples of the fluid or pleura tissue for testing. This may be done with:
Treatment depends on what is causing the problem. It may include medicines or surgery.
If your symptoms are minor, your doctor may choose to monitor you until the effusion is gone.
If you are having trouble breathing, your doctor may advise:
- Breathing medicine into the lungs
- Oxygen therapy
Drain the Pleural Effusion
The pleural effusion may be drained by:
- Therapeutic thoracentesis —a needle is used to withdraw excess fluid.
- Tube thoracostomy—a tube is placed in the side of your chest to let fluid drain. It will be left in place for several days.
Seal the Pleural Layers
The doctor may advise chemical pleurodesis. Talc powder or an irritating chemical is injected into the pleural space. This will seal the two layers of the pleura together. This may help prevent further fluid buildup.
Radiation therapy may also be used to seal the pleura.
In severe cases, surgery may be done. Some of the pleura will be removed during surgery. Options are:
- Thoracotomy —traditional, open chest procedure
- Video-assisted thorascopic surgery (VATS)—surgery that uses small keyhole size incisions
Manage health problems that may lead to effusion.
- Pleural effusion. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T474331/Pleural-effusion . Updated April 30, 2018. Accessed August 28, 2018.
- Pleural effusion. Merck Manual Professional Version website. Available at: http://www.merckmanuals.com/professional/pulmonary-disorders/mediastinal-and-pleural-disorders/pleural-effusion. Updated October 2017. Accessed August 28, 2018.
- Pleural effusion. Remedy's Health Communities website. Available at: http://www.healthcommunities.com/pleural-effusion/overview-of-pleural-effusion.shtml. Updated October 1, 2015. Accessed August 28, 2018.
- 12/10/2010 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T474331/Pleural-effusion : Roberts M, Neville E, Berrisford R, Atunes G, Ali N, et al. Management of a malignant pleural effusion: British Thoracic Society pleural disease guideline 2010. Thorax. 2010;65 Suppl 2:ii32.