(Water on the Lungs)
DefinitionThe 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 can prevent the lungs from fully opening. This can make it difficult to catch your breath.Pleural effusion may be watery (transudative) or thick (exudative) based on the cause. Treatment of pleural effusion depends on the condition causing the effusion.
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CausesEffusion is usually caused by disease or injury.Transudative effusion may be caused by:
- Heart failure or pericarditis
- Pulmonary embolism
- Liver diseasePancreatitis
- Kidney disease
- A large shift in body fluids
- Pneumonia and other lung infections
- Rheumatic disease, such as sarcoidosis
- Anti-inflammatory diseases, such as Lupus
- Cancer, especially of the lung , breast , or lymph system
- Blood clot formation in the lung
Risk FactorsFactors that increase your chance of getting pleural effusion include:
- Having conditions or diseases listed above
- Certain medications such as:
- Chest injury or trauma
- Radiation therapy
- Surgery, especially involving:
- Organ transplantation
SymptomsSome types of pleural effusion do not cause symptoms. Others cause a variety of symptoms, including:
- Shortness of breath
- Chest pain
- Stomach discomfort
- Coughing up blood
- Shallow breathing
- Rapid pulse or breathing rate
- Weight loss
- Fever, chills, or sweating
DiagnosisThe 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. Lung function tests will test your ability to move air in and out of your lungs.Some blood tests will be done based on what the doctor thinks it causing the fluid.Images of your lungs may be taken with:
TreatmentTreatment is usually aimed at treating the underlying cause. This may include medications or surgery.Your doctor may take a "watchful waiting" approach if your symptoms are minor. You will be monitored until the effusion is gone.
To Support BreathingIf you are having trouble breathing, your doctor may recommend:
- Breathing treatments—inhaling medication directly to lungs
- Oxygen therapy
Drain the Pleural EffusionThe pleural effusion may be drained by:
- Therapeutic thoracentesis —a needle is inserted into the area to withdraw excess fluid.
- Tube thoracostomy—a tube is placed in the side of your chest to allow fluid to drain. It will be left in place for several days.
Seal the Pleural LayersThe 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. The seal may help prevent further fluid buildup.Radiation therapy may also be used to seal the pleura.
SurgeryIn severe cases, surgery may be needed. Some of the pleura will be removed during surgery. Suregery options may include:
- Thoracotomy —traditional, open chest procedure
- Video-assisted thorascopic surgery (VATS)—minimally-invasive surgery that only requires small keyhole size incisions
PreventionPrompt treatment for any condition that may lead to effusion is the best way to prevent pleural effusion.
American Lung Association
National Heart, Lung, and Blood Institute
The Canadian Lung Association
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12/10/2010 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Roberts M, Neville E, Berrisford R, Atunes G, Ali N. Management of a malignant pleural effusion: BritishThoracic Society pleural disease guideline 2010.Thorax . 2010;65 Suppl 2:ii32.
- Reviewer: Michael Woods, MD
- Review Date: 02/2014
- Update Date: 06/24/2013