Pleural Effusion

Pleural effusion is an abnormal buildup of fluid in the layers of tissue between the lungs and the inside of the chest (pleural space) The two layers of tissue that line the lungs and the inside of the chest are called pleura.

Usually, there is no air in the space between the pleura, only a thin layer of fluid. Some conditions can cause a large amount of fluid to build up, which can cause the lung to collapse if untreated. A pleural effusion is usually caused by another disease that requires treatment.

What are the causes?

Pleural effusion can be caused by:

• Heart failure.
• Certain infections, such as pneumonia or tuberculosis.
• Cancer.
• A blood clot in the lung (pulmonary embolism).
• Complications from surgery, such as from open heart surgery.
• Liver disease (cirrhosis).
• Kidney disease.

What are the signs or symptoms?

In some cases, pleural effusion may cause no symptoms. If symptoms are present, they may include:

• Shortness of breath, especially when lying down.
• Chest pain. This may get worse when taking a deep breath.
• Fever.
• Dry, long-lasting (chronic) cough.
• Hiccups.
• Rapid breathing.

An underlying condition that is causing the pleural effusion (such as heart failure, pneumonia, blood clots, tuberculosis, or cancer) may also cause other symptoms.

How is this diagnosed?

This condition may be diagnosed based on:

• Your symptoms and medical history.
• A physical exam.
• A chest X-ray.
• A procedure to use a needle to remove fluid from the pleural space (thoracentesis). This fluid is tested.
• Other imaging studies of the chest, such as ultrasound or CT scan.

How is this treated?

Depending on the cause of your condition, treatment may include:

• Treating the underlying condition that is causing the effusion. When that condition improves, the effusion will also improve. Examples of treatment for underlying conditions include:
  • Antibiotic medicines to treat an infection.
  • Diuretics or other heart medicines to treat heart failure.
• Thoracentesis.
• Placing a thin flexible tube under your skin and into your chest to continuously drain the effusion (indwelling pleural catheter).
• Surgery to remove the outer layer of tissue from the pleural space (decortication).
• A procedure to put medicine into the chest cavity to seal the pleural space and prevent fluid buildup (pleurodesis).
• Chemotherapy and radiation therapy, if you have cancerous (malignant) pleural effusion. These treatments are typically used to treat cancer. They kill certain cells in the body.

Follow these instructions at home:

• Take over-the-counter and prescription medicines only as told by your health care provider.
• Ask your health care provider what activities are safe for you.
• Keep track of how long you are able to do mild exercise (such as walking) before you get short of breath. Write down this information to share with your health care provider. Your ability to exercise should improve over time.
• Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. If you need help quitting, ask your health care provider.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

• The amount of time that you are able to do mild exercise:
  • Decreases.
  • Does not improve with time.
• You have a fever.

Get help right away if:

• You are short of breath.
• You develop chest pain.
• You develop a new cough.

Summary

• Pleural effusion is an abnormal buildup of fluid in the layers of tissue between the lungs and the inside of the chest.
• Pleural effusion can have many causes, including heart failure, pulmonary embolism, infections, or cancer.
• Symptoms of pleural effusion can include shortness of breath, chest pain, fever, long-lasting (chronic) cough, hiccups, or rapid breathing.
• Diagnosis often involves making images of the chest (such as with ultrasound or X-ray) and removing fluid (thoracentesis) to send for testing.
• Treatment for pleural effusion depends on what underlying condition is causing it.