Pleural effusion
What is pleural effusion?
Lungs are enclosed between two layers of thin membranes called pleurae (singular pleura), which line the inner surface of the chest cavity and the outer surface of the lungs. They form a sac like structure enclosing the lungs. There is a thin layer of fluid in the sac called as the pleural fluid which acts to lubricate and facilitate the process of breathing. Pleural effusion, means accumulation of abnormal and excess fluid between the two layers of the pleura, outside the lungs.
Is pleural effusion serious?
Pleural effusion as we have discussed is an abnormal collection of fluid. The seriousness of this condition depends on the underlying cause of pleural effusion, whether the breathing is affected, and whether it can be managed effectively. For example, small amounts of fluid collected as a result of viral or acute bacterial infection, may not require anything other than effective treatment of the underlying disease. Whereas large effusions which cause respiratory discomfort or breathing difficulty need to be removed or drained.
What are the symptoms of pleural effusion?
Pleural effusions could be totally asymptomatic and could be detected as a chance finding on chest x ray, or may present with the following symptoms:
- Dry, no productive cough
- Chest pain
- Breathlessness or fast breathing
- Difficulty in breathing when the patient is lying down
What causes pleural effusion?
Depending on the underlying cause, the excessive fluid may be low in protein content called as a transudate or high in protein content called as an exudate.
Common causes of a transudative pleural effusions are:
- Infections – in 50% to 70% of cases of lung infections also called as parapneumonic effusions
- Congestive heart failure
- Nephrotic syndrome
- Ascites
- Cirrhosis
- Causes of an exudative pleural effusion are:
- Infections – like viral, tuberculosis, bacterial, parasitic
- Malignancy – primary or metastatic
- Connective tissue disorder – SLE, rheumatoid arthritis
- Immunological – sarcoidosis
- Gastro – intestinal – abscess, hepatitis related
Pyothorax causes:
Infections: bacterial tuberculosis, fungal, amoebic
Hemothorax causes : trauma, surgery, bleeding disorders
Chylothorax causes: : Post – surgery, congenital, idiopathic when the cause can’t be found, malignancy, trauma
How is pleural effusion diagnosed?
The tests most commonly used to diagnose and evaluate pleural effusion include:
- o Chest x ray
- o CT (computerized tomography) chest
- o Lung ultrasound
- o Pleural tap or Thoracentesis (removal of fluid for investigations by inserting a needle is inserted between the ribs) and analysis of the pleural fluid.
- o Thoracoscopy which is the direct visualization of the pleural space by thoracoscope.
- o Video-assisted thoracoscopic surgery, or VATS, performed under general anaesthesia when any interventions or biopsy has to be taken.
How is pleural effusion treated?
Treatment is basically treating the underlying condition and treatment of complications like breathlessness or breathing difficulty.
- Infections are treated with appropriate antibiotics
- Anti - tuberculosis drugs may be needed in cases of tuberculosis
- Diuretics and other medications for congestive heart failure
- In case of breathing difficulty or distress, the fluid may have to be removed by inserting a chest tube called as tube thoracostomy.
When is Surgery required?
Rarely surgery may be required when there is no response or recurrences occur despite the best interventions.
- Video-assisted thoracoscopic surgery (VATS) A minimally-invasive approach or thoracoscopic surgery. Sterile talc or an antibiotic could be inserted to prevent recurrence.
- Thoracotomy (“open” thoracic surgery) A thoracotomy is performed when infections are present. It is done to all of the fibrous tissue and following this surgery, patients require chest tubes for 2 to 14 days to continue draining fluid.