What is the definition of Pleural Effusion?

A pleural effusion is a buildup of fluid between the layers of tissue that line the lungs and chest cavity.

What are the alternative names for Pleural Effusion?

Fluid in the chest; Fluid on the lung; Pleural fluid

What are the causes for Pleural Effusion?

The body produces pleural fluid in small amounts to lubricate the surfaces of the pleura. This is the thin tissue that lines the chest cavity and surrounds the lungs. Pleural effusion is an abnormal, excessive collection of this fluid.

There are two types of pleural effusion:

• Transudative pleural effusion is caused by fluid leaking into the pleural space. This is from increased pressure in the blood vessels or a low blood protein count. Heart failure is the most common cause.
• Exudative effusion is caused by blocked blood vessels or lymph vessels, inflammation, infection, lung injury, and tumors.

Risk factors of pleural effusion may include:

• Smoking and drinking alcohol, as these can cause heart, lung and liver disease, which can lead to pleural effusion
• History of any contact with asbestos

What are the symptoms for Pleural Effusion?

Symptoms can include any of the following:

• Chest pain, usually a sharp pain that is worse with cough or deep breaths
• Cough
• Fever and chills
• Hiccups
• Rapid breathing
• Shortness of breath

Sometimes there are no symptoms.

What are the current treatments for Pleural Effusion?

The goal of treatment is to:

• Remove the fluid
• Prevent fluid from building up again
• Determine and treat the cause of the fluid buildup

Removing the fluid (thoracentesis) may be done if there is a lot of fluid and it is causing chest pressure, shortness of breath, or a low oxygen level. Removing the fluid allows the lung to expand, making breathing easier.

The cause of the fluid buildup must also be treated:

• If it is due to heart failure, you may receive diuretics (water pills) and other medicines to treat heart failure.
• If it is due to an infection, antibiotics will be given.
• If it is from cancer, liver disease, or kidney disease, treatment should be directed at these conditions.

In people with cancer or infection, the effusion is often treated by using a chest tube to drain the fluid and treating its cause.

In some cases, any of the following treatments are done:

• Chemotherapy
• Placing medicine into the chest that prevents fluid from building up again after it is drained
• Radiation therapy
• Surgery

What is the outlook (prognosis) for Pleural Effusion?

The outcome depends on the underlying disease.

What are the possible complications for Pleural Effusion?

Complications of pleural effusion may include:

• Lung damage
• Infection that turns into an abscess, called an empyema
• Air in the chest cavity (pneumothorax) after drainage of the effusion
• Pleural thickening (scarring of the lining of the lung)

When should I contact a medical professional for Pleural Effusion?

Call your provider or go to the emergency room if you have:

• Symptoms of pleural effusion
• Shortness of breath or difficulty breathing right after thoracentesis

REFERENCES

Blok BK. Thoracentesis. In: Roberts JR, Custalow CB, Thomsen TW, eds. Roberts and Hedges' Clinical Procedures in Emergency Medicine and Acute Care. 7th ed. Philadelphia, PA: Elsevier; 2019:chap 9.

Broaddus VC, Light RW. Pleural effusion. In: Broaddus VC, Mason RJ, Ernst JD, et al, eds. Murray and Nadel's Textbook of Respiratory Medicine. 6th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 79.

McCool FD. Diseases of the diaphragm, chest wall, pleura and mediastinum. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 92.