What is Pleural Effusion?

What is pleural effusion? To answer this question, certain terms must be defined first.

Pleura – a delicate membrane that encloses the lungs. The pleurae are divided into two areas separated by fluid: the visceral pleura, which cover the lungs, and the parietal pleura, which line the chest wall and cover the diaphragm.

Pleural cavity – the area of the thorax that contains the lungs

Pleural space – the area between the visceral and parietal layers of the pleurae

Therefore, pleural effusion is the condition of having excess fluid in the pleural space. It is not a disease as others might have supposed, but rather a result of an underlying cause.

Normally, a little amount of fluid is present in the pleural space necessary to lubricate the surfaces of the pleurae.

Pleural Effusion Symptoms

The following are the most common symptoms of pleural effusion:

• Fever
• Rapid breathing
• Chest and back pain
• Hiccups
• Shortness of breath
• Chest pressure
• Dyspnea
• Cough

Chest pressure normally takes place only when the effusion is in the moderate (500-1500 mL) to large (>1500 mL) category.

In some cases, there are actually no symptoms.

Causes of Pleural Effusion

Knowing what is pleural effusion is not enough. Understanding its causes is vital to performing the best medical approach in every situation.

There are two types of pleural effusion: transudative and exudative.

1. A transudative pleural effusion is one producing a clear fluid. This is not a disease in the pleura itself, but rather an imbalance in the removal and intake of pleural fluid.

Forty percent of the time, congestive heart failure is the known main cause of pleural effusion. As a result, a bilateral type of effusion is usually observed. For a one-sided effusion, the right part of the lungs is frequently the one affected because people tend to lie on the right side.

2. Exudative pleural effusion comes about when the pleura itself is diseased.The causes are several and varying, most common of which are infections due to bacterial pneumonia and tuberculosis.

In developing countries, tuberculosis is noticed as the leading cause of pleural effusion. However, pleural effusion is most likely related to bacterial pneumonia in as much as 50% of all cases.

Treatment may be geared at removing the fluid, preventing it from accumulating again, or addressing the underlying cause of the buildup.

Thoracentesis is used both in diagnosis and treatment. In treatment, a syringe is attached to a needle that is inserted in the chest to draw out fluid.

This procedure can remove only more than six cups of fluid at a time.

Patients who have only small amounts of pleural fluid and respond clinically to antibiotic therapy are not required to have thoracentesis.

If the effusion is not completely removed by thoracentesis, the presence of loculations can be presumed.

Additionally, if the accumulation of fluid is fast, drainage with a chest tube is generally opted. Only surgeons perform this procedure.

Depending on the surgeon, a patient may sit erect on a chair or lie down on the bed with his hand placed at the back of his head.

In this case, the consent of the family and the patient is sought by making them sign a waiver, absolving the hospital and the physicians of any criminal liability for any untoward incidence that may happen during the course of the procedure. This seems rather unfair on the part of the patient and his family.

The chest tube is inserted into the pleural space between the ribs on the patient’s side. The tube’s diameter is commonly as big as a small finger. The chest thoracoscopy tube (CTT) is left in place for several days or even weeks until drainage stops or is minimally low.

Also, the CTT will not be removed if air appears in the chest x-ray result. Frequent chest x-ray or ultrasound is done to monitor the amount of fluid remaining in the pleural space.

• A lung may collapse if it is surrounded with excess fluid for a long time.
• An infected pleural fluid may turn into an abscess, called an empyema, which requires prolonged drainage with a chest tube.
• The thoracentesis procedure may cause buildup of air in the pleural space. Air sometimes comes in through the needle, or the needle creates a hole in the lung. However, a hole heals itself naturally.
• Clogging can be a major complication of CTT placement. Reinsertion (even multiple reinsertions) is often applied to completely remove the fluid.

I strived hard to cover all the important details concerning pleural effusion, from symptoms to treatment. This is to give you a clear understanding of this malady.

After I experienced the condition firsthand, I feel obligated to help spread the word to everyone. My next hub, My Painful Experience with Pleural Effusion, will give you some insights into my battle with this disorder.

You will also gain inspiration knowing I was able to deal with the condition. It was a near-death experience, I tell you. But with God's help and my strong will, I successfully made it back to my normal life, despite some limitations.