Pleural Effusion
What is Pleural Effusion?
“PLEURAL EFFUSION IS FLUID COLLECTION OUTSIDE THE LUNGS DUE TO DISEASE. IT NEEDS URGENT EVALUATION FOR FURTHER DIAGNOSIS AND PROPER TREATMENT.”
Pleural effusion is a collection of excess fluid in the space between the two layers of pleura. This can compress the lung and may cause shortness of breath. A pleural effusion is usually the result of damage to the pleural membrane and may be due to many disease processes – your doctor will discuss the specific cause of your effusion with you. Treatment involves draining the excess fluid from the pleural space via a needle or a thin chest drain/tube which is inserted through the chest wall into the space between the two layers of pleura. This enables the excess fluid to drain and usually stays in place untilthe fluid has drained and the lung has re- expanded. (This is decided by chest x-ray or sometimes a scan is needed).
What is the cause of the pleural effusion?
Pleural effusions will be commonly caused due to:
1. Lung infection (pneumonia), tuberculosis, and cancers may cause inflammation of the lung and pleura. This may cause fluid to build up into a pleural effusion.
2. Some arthritic conditions may cause inflammation of the pleura in addition to
joint inflammation. For example, pleural effusion is an uncommon complication of rheumatoid arthritis and systemic lupuserythematosis (SLE).
3. Heart failure causes 'back pressure' in the veins (blood vessels) that take blood back to the heart. Some fluid may seep out of the blood vessels. Swelling of the legs with fluid is typical with heart failure, but a pleural effusion may also develop.
4. A low level of protein in the blood also tends to allow fluid to seep out of the blood vessels. For example, cirrhosis of the liver and some kidney diseases may cause a low level of blood protein which allows a pleural effusion to develop.
5. Pleural fluid of unknown causes in selected cases especially abdominal
infection / trauma / post peritoneal dialysis.
What are the symptoms of pleural effusion?
Symptoms of the pleural effusion include the1. Breathing difficulty
2. Cough
3. Chest pain
4. Fever for infections
5. Heaviness on the chest
6. Inability to lie down flat on the bed.
Other nonspecific symptoms related to underlying disease include the weight loss / fatigue / change in voice / reduced appetite.
What can be done?
Tests usually done include an X Ray Chest CT scan, complete blood evaluation, Ultrasound evaluation of abdomen / chest, Pleural tapping and evaluating the fluid for different diseases. Please read through the leaflet on Pleural tapping and thoracoscopy for further information on how to evaluate the patient with such diseases.What am I to expect after tests?
The tests results may suggest some problems either of infection or cancers or may be of an uncertain cause. This needs further evaluation and thus pleural tapping may be recommended. This may occur in the ultrasound guidance or as an outpatient procedure depending on initial ultrasound evaluation. The reports of the pleural fluid may help understand the disease process and final medical management.What are the costs of testing for pleural effusion?
Considering that the procedure is done in an indoor / hospital setting, it will vary among different hospitals. Please discuss this with the doctor / hospital billing section.What is Pleurodesis?
In certain cases the fluid can build up again after drainage and so to prevent this, a procedure called pleurodesis is performed. Pleurodesis involves injecting a solution into the pleural space through the chest drain tube. The solution will be made up of sterile talc, normal saline and local anaesthetic. The chest drain will then be clamped for 2 - 4 hours to prevent the talc solution from flowing back out immediately. Following the pleurodesis you will be asked to change your position regularly to improve the distribution of the solution. Pleurodesiscauses the two layers of pleura to become inflamed so that when the lung re-expands they stick together and the lung is anchored to the chest wall. This should prevent the fluid from re-accumulating. The procedure is more effective if the fluid has been drained off completely leaving the pleural space completely dry; suction may therefore be applied to the drain before the procedure takes place. The chest drain will be left in position for a few hours after the procedure and may in some cases be re-attached to suction to help the lung stick against the chest wall. Occasionally fluid may drain from the pleural space for a while after the pleurodesis and the drain will be left in until this slows right down or stops. After the procedure has been performed you will experience some pain on that side of the chest. Please make sure that you are as pain- free as possible by asking for painkillers regularly. If you have any questions about your chest drain, pleural effusion or pleurodesis please do not hesitate to ask the nurses or doctors looking after you.
* This leaflet is for patient education, information and counselling not for distribution and commercial purposes.
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