Introduction

Pleural effusion, which some people call "water on the lungs," happens when excess fluid builds up between the two layers of the pleura outside your lungs. The pleura are thin membranes that cover your lungs and line the inside of your chest cavity. Everyone has a small amount of fluid in their pleural cavity. Pleural fluid works as a natural lubricant and helps your lungs move when you breathe. However, with pleural effusion, there is too much fluid around your lungs. This means your body makes too much of the fluid or doesn't absorb enough of the fluid it produces.

Types of Pleural Effusion

Doctors group pleural effusion into two categories, based on the type of fluid surrounding the lungs. The extra fluid can be:

Low protein content (transudative): This fluid often results from conditions like cirrhosis or heart failure. This kind of pleural effusion occurs when fluid pressure increases. High in protein (exudative): This fluid stems from cancer or an infection. This form of pleural effusion happens because too much fluid leaks through your tiniest blood vessels or your lymph system fails to drain.

Symptoms

You might experience symptoms unrelated to the pleural effusion that stem from the underlying disease or condition. Pleural effusion has an impact on your health in these ways: Pain in the chest - It gets worse when you cough or breathe Dyspnea - Trouble breathing or laboured breathing Orthopnea - You can breathe when sitting or standing upright

Causes of Pleural Effusion

• Transudative pleural effusions often result from:
• Heart failure
• Cirrhosis
• Nephrotic syndrome (a kidney problem)
• Exudative (protein-rich fluid) pleural effusions stem from:
• Pneumonia
• Cancer (lung cancer, breast tumour or lymphoma)
• Kidney disease
• Inflammatory disease
• Post open-heart surgery
• Less common causes of pleural effusion are:
• Tuberculosis
• Autoimmune disease
• Bleeding from chest trauma
• Chylothorax (chyle from your lymphatic system after trauma)
• Rare chest & abdominal infections
• Exposure to asbestos
• Oesophageal rupture
• Pancreatitis
• Meig's syndrome (from a benign ovarian tumour)
• Ovarian hyperstimulation syndrome
• Certain medications
• Abdominal surgery
• Radiation therapy

Risk Factors of Pleural Effusion

Factors that can lead to pleural effusion include:

• Health problems that cause it
• Smoking
• Contact with asbestos

Diagnosis

Doctors use these tests to check for and look at pleural effusion:

• X-ray of your chest: Shows fluid accumulation and reveals the effusion's size and position.
• CT scan of your chest: Provides clear images that help determine the reason and amount of the fluid.
• Ultrasound of your chest: Locates fluid and helps doctors drain or take samples
• Thoracentesis or biopsy: Putting a needle between your ribs to take out some fluid
• Pleural fluid analysis: Looking at the fluid from the space around your lungs

Treatment

The goal of treating pleural effusion is to remove extra fluid and stop it from building up again. Doctors develop a treatment plan based on what's causing the problem and if you are having trouble breathing.

Medications

• Doctors use diuretics and other heart medicines to treat pleural effusion caused by heart failure or other health issues.
• Doctors prescribe antibiotics to treat infections.
• If cancer is behind the effusion, you might also need chemotherapy, radiation therapy, or certain medicines.

Procedures

• A doctor can drain a pleural effusion that's making it hard to breathe. They do this by using a needle or putting in a chest tube.
• Even with drainage pleural effusions can be tough to manage or may recur due to cancer. In such cases, a doctor injects a sclerosing agent (a drug that creates scarring on purpose) into your pleural cavity through a chest tube.
• Surgery
• You might need to undergo surgery if drainage or pleural sclerosis don't work.
• The two types of surgery include:
• Video-assisted thoracoscopic surgery (VATS). VATS has the ability to manage pleural effusions that are hard to drain or that return because of a tumour. A doctor can put sterile talc or an antibiotic during surgery to stop fluid from building up again.
• Thoracotomy (traditional, open chest surgery): A surgeon cuts a 6-inch to 8-inch opening in your chest to perform a thoracotomy. They choose this method when you have an infection. A thoracotomy gets rid of all the fibrous tissue and helps clean out the infection from the space around your lungs.
• After surgery, you'll need tubes in your chest for two days to two weeks to keep draining fluid.