Definition

Pleural effusion is the buildup of excess fluid in the space between the pleura. The pleura are two thin, moist membranes around the lungs. There are two layers of pleura:

• Inner layer—attached to the outside of the lungs
• Outer layer—lines the inside of the rib cage

There are two types of effusion: transudative and exudative , each having unique diagnostic properties. The two types have different causes, but in both cases, excess fluid prevents the lungs from fully expanding and causes shortness of breath.

Pleural Effusion

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Causes

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

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition.

• Pneumonia, tuberculosis, or other lung diseases
• Heart attack , heart failure, or infections such as pericarditis , recent cardiac surgery
• Inflammation or infection of the pleura
• Liver disease
• Tumors
• Pregnancy
• Connective tissue diseases, such as rheumatoid arthritis and lupus
• Certain medications:
  • Nitrofurantoin
  • Dantrolene
  • Methysergide
  • Bromocriptine
  • Procarbazine
  • Amiodarone
• Cancers, such as lung, breast, lymphoma, or mesothelioma
• Chest injury or trauma
• Radiation therapy
• Pulmonary embolus (blood clot in the lungs)
• Abdominal infections or pancreatitis
• Surgery, especially involving
  • Heart
  • Lungs
  • Abdomen
  • Organ transplantation

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, and perform a physical exam. 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. If breathing is impaired, breathing treatments or supplemental oxygen may be given. The pleural effusion may be drained by inserting a needle into the area and withdrawing fluid (therapeutic thoracentesis) or by inserting a chest tube (tube thoracostomy) into the side of your chest and leaving it in place for several days, eventually attached to suction.

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

Prevention

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