Pleural Effusion: Type, Symptoms & Causes, Treatments, and Prevention

 What Is a Pleural Effusion?

A Pleural Effusion is a medical condition characterized by the accumulation of excess fluid in the pleural space, which is the space between the membranes lining the lungs and the chest cavity.

 This condition can occur due to various underlying causes, including infections, congestive heart failure, malignancies, pulmonary embolism, liver or kidney diseases, and inflammatory conditions like pneumonia or lupus. Symptoms of a pleural effusion may include chest pain, difficulty breathing, coughing, and in severe cases, respiratory distress.

Types of Pleural Effusion :

Healthcare providers split pleural effusion into two types, depending on the kind of fluid around your lungs.

Excess fluid may be:

• Protein-poor and watery (transudative): Fluid of this kind comes from cirrhosis or heart failure, for example. This type of pleural effusion happens when there’s an increase in pressure from the fluid.

• Protein-rich (exudative): Fluid of this kind comes from cancer or an infection, for example. This type of pleural effusion happens because too much fluid is getting through your smallest blood vessels or your lymphatic system isn’t draining enough.

Symptoms and Causes :

What are the Symptoms of Pleural Effusion?

You may have unrelated symptoms due to the disease or condition that caused pleural effusion. Pleural effusion symptoms include:

• Chest pain. Coughing or deep breathing makes it worse.

• Dyspnea (shortness of breath, or difficult, labored breathing).

• Orthopnea (the inability to breathe easily unless you’re sitting up straight or standing up straight).

Some people with pleural effusion have no symptoms. They find out they have pleural effusion when they have a Chest X-Ray for another reason.

What causes Pleural Effusion?

There are many causes of pleural effusion, and some people have more than one.

Depending on the cause, the excess fluid may be either protein-poor (transudative) or protein-rich (exudative). These two categories help providers determine the cause of the pleural effusion. A Pulmonary Embolism (PE) can fall under either category.

The most common causes of transudative (watery fluid) pleural effusions include:

• Heart failure.

• Cirrhosis.

• Nephrotic syndrome (a kidney issue).

Common causes of exudative (protein-rich fluid) pleural effusions include:

• Pneumonia.

• Cancer (lung cancer, breast cancer or lymphoma).

• Kidney disease.

• Inflammatory disease.

• Post open-heart surgery.

Less common causes of pleural effusion include:

• Tuberculosis.

• Autoimmune disease.

• Bleeding from chest trauma.

• Chylothorax (chyle from your lymphatic system after trauma).

• Rare chest and abdominal infections.

• Exposure to asbestos.

• Esophageal rupture.

• Pancreatitis.

• Meig’s syndrome (from a benign ovarian tumor).

• Ovarian hyperstimulation syndrome.

• Certain medications.

• Abdominal surgery.

• Radiation therapy.

In some cases, the fluid itself may have malignant (cancerous) cells or may be a direct result of Chemotherapy.

What are the risk factors for Pleural Effusion?

Risk factors for Pleural Effusion include:

• Medical Conditions: Various medical conditions can predispose individuals to develop pleural effusion. These include congestive heart failure, pneumonia, tuberculosis, lung cancer, autoimmune diseases such as lupus or rheumatoid arthritis, liver or kidney diseases, and pulmonary embolism, among others.

• Smoking/Tobacco Use: Smoking or using tobacco products can increase the risk of developing certain respiratory conditions, including pleural effusion. Smoking damages the lungs and increases susceptibility to infections and other respiratory issues.

• Exposure to Asbestos: Asbestos exposure is a significant risk factor for developing pleural effusion. Asbestos fibers, when inhaled, can lead to inflammation and scarring of the lung tissue, eventually causing conditions such as pleural plaques, pleural thickening, and pleural effusion.

Diagnosis and Tests :

How is Pleural Effusion Diagnosed ?

A provider will ask you about your medical history. They’ll ask what other illnesses you have and when your symptoms started. They’ll do a Physical Exam, which includes listening to your lungs when you breathe. Next, they’ll order tests.

What tests will be done to diagnose Pleural Effusion ?

Healthcare providers use these tests to diagnose and evaluate pleural effusion:

• Chest X-Ray.

• Computed tomography (CT) scan of your chest.

• Ultrasound of your chest.

• Thoracentesis or biopsy (inserting a needle between your ribs to remove a fluid sample).

• Pleural fluid analysis (examining the fluid from the pleural space).

If less invasive tests don’t diagnose pleural effusion, you may need a thoracoscopy. Thoracoscopy is a minimally invasive technique, also known as video-assisted thoracic surgery, or VATS. A provider performs this while you’re under general anesthesia. Thoracoscopy allows them to see and evaluate your pleura. Often, they’ll treat your effusion during the thoracoscopy.

Prevention

How can I lower my risk of Pleural Effusion?

Here are some preventive measures that can help reduce the risk of pleural effusion:

• Avoiding Tobacco Products: Quitting smoking and avoiding exposure to secondhand smoke can reduce your risk of developing respiratory conditions, including pleural effusion.

• Avoiding Asbestos Exposure: Minimize exposure to asbestos by following safety guidelines in workplaces where asbestos may be present. If you work in an industry with potential asbestos exposure, ensure proper protective measures are in place.

• Following Dietary Recommendations: If your healthcare provider advises you to follow a low-salt diet, sticking to low-sodium meals can help manage conditions like congestive heart failure and reduce the risk of fluid accumulation that can lead to pleural effusion.

• Taking Prescribed Medications: If you have conditions like congestive heart failure or kidney disease, taking prescribed diuretics (water pills) as directed by your healthcare provider can help manage fluid retention and reduce the risk of pleural effusion.

• Monitoring Fluid Intake: In some cases, healthcare providers may recommend limiting fluid intake to prevent fluid overload and subsequent pleural effusion, especially in individuals with certain cardiac or renal conditions.

• Managing Underlying Health Conditions: Proper management and treatment of underlying conditions such as heart failure, pneumonia, tuberculosis, or autoimmune diseases can help reduce the risk of developing pleural effusion.