Pleural Effusion

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(Water on the Lungs)  

by Michelle Badash, MS

En Español (Spanish Version)


* Definition  

The pleura are two thin, moist membranes around the lungs. The inner layer is attached to the lungs. The outer layer is attached to the ribs. Pleural effusion is the buildup of excess fluid in the space between the pleura. The fluid prevents the lungs from fully expanding. This causes shortness of breath. There are two layers of pleura:

There are two types of effusion:

  • Transudative
  • Exudative

Pleural Effusion  

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© 2009 Nucleus Medical Art, Inc.

* Causes  

Effusion is usually caused by disease or injury. The two types have different causes:

Causes of Transudative Effusion  

  • Heart failure
  • Malnutrition
  • Liver disease
  • Kidney disease
  • A large shift in body fluids, such as during childbirth
  • Presence of a tumor

Causes of Exudative Effusion  

* Risk Factors  

Factors that increase your chance of getting pleural effusion include:

* Symptoms  

Some types of pleural effusion do not cause symptoms. Others cause a variety of symptoms, including:

  • Shortness of breath
  • Chest pain
  • Stomach discomfort
  • Cough
  • Coughing up blood
  • Shallow breathing
  • Rapid pulse or breathing rate
  • Weight loss
  • Fever, chills, or sweating
  • Hiccupping

* Diagnosis  

The doctor will ask about your symptoms and medical history. A physical exam will be done. This may include listening to or tapping on your chest.

Tests may include:

  • Chest x-ray—a test that uses radiation to take a picture of structures inside the chest
  • Ultrasound—a test that uses sound waves to examine structures inside the chest
  • CT scan—a type of x-ray that uses a computer to make pictures of structures in the chest
  • Thoracentesis—fluid sample extracted from the pleural space around the lungs with a needle
  • Pulmonary function tests—to check breathing ability
  • Biopsy—removal of a sample of pleural tissue for testing

* Treatment  

Treatment is usually aimed at treating the underlying cause. This may include treating:

  • Heart failure
  • Blood clots in the lungs
  • Infection by administering antibiotics

To Support Breathing  

If breathing is impaired you may receive:

  • Breathing treatments
  • Supplemental oxygen

Drain the Pleural Effusion  

The pleural effusion may be drained by:

  • Therapeutic thoracentesis—done by inserting a needle into the area and withdrawing fluid
  • Tube thoracostomy—inserting a chest tube into the side of your chest and leaving it in place for several days, eventually attached to suction

Seal the Pleural Layers  

In some cases, the doctor may recommend chemical pleurodesis. During this procedure, talc powder or an irritating chemical is injected into the pleural space. This will permanently seal the two layers of the pleura together. This may help prevent further fluid build up.

Radiation therapy may also be used to achieve this purpose.

Surgery  

In severe cases, surgery may be needed. It is done to remove some of the pleura and resolve the pleural effusion. This may be accomplished through:

  • Thoracotomy—traditional, open chest procedure
  • Video-assisted thorascopic surgery (VATS)—minimally-invasive type of keyhole surgery

* Prevention  

The best way to prevent pleural effusion is to get prompt treatment for any condition that may lead to it.

Last reviewed January 2009 by Rosalyn Carson-DeWitt, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

Copyright © 2009 EBSCO Publishing. All rights reserved.

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