Pleural effusion health promotion and disease prevention

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

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

Your health care provider will examine you and ask about your symptoms. The provider will also listen to your lungs with a stethoscope and tap (percuss) your chest and upper back.

Chest CT scan or a chest x-ray may be enough for your provider to decide on treatment.

Your provider may want to perform tests on the fluid. If so, a sample of fluid is removed with a needle inserted between the ribs. Tests on the fluid will be done to look for:

• Infection
• Cancer cells
• Protein levels
• Cell counts
• Acidity of the fluid (sometimes)

Blood tests that may be done include:

• Complete blood count (CBC), to check for signs of infection or anemia
• Kidney and liver function blood tests

If needed, these other tests may be done:

• Ultrasound of the heart (echocardiogram) to look for heart failure
• Ultrasound of abdomen and liver
• Urine protein testing
• Lung biopsy to look for cancer
• Passing a tube through the windpipe to check the airways for problems or cancer (bronchoscopy)

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

The outcome depends on the underlying disease.

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)

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

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

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.

Updated by: Denis Hadjiliadis, MD, MHS, Paul F. Harron, Jr. Associate Professor of Medicine, Pulmonary, Allergy, and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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Pleural Effusion

Conditions Basics

What is pleural effusion?

A pleural effusion (say "PLER-uhl eh-FYOO-zhun") is the buildup of fluid in the pleural space. This is the space between the tissues lining the lungs and the chest wall. Because of the fluid buildup, the lungs may not be able to expand completely. This can make it hard to breathe.

A pleural empyema (say "em-py-EE-muh") is a problem that can happen with pleural effusion. Bacteria or other infections cause pus to form in the pleural fluid. But most pleural effusions don't become infected.

What causes it?

A pleural effusion has many causes. They include pneumonia, cancer, inflammation of the tissues around the lungs, and heart failure.

What are the symptoms?

Symptoms of a pleural effusion may include:

• Trouble breathing.
• Shortness of breath.
• Chest pain.
• Fever.
• A cough.

A minor pleural effusion may not cause any symptoms.

How is it diagnosed?

A pleural effusion is usually diagnosed with an X-ray and a physical exam. The doctor listens to the airflow in your lungs.

How is pleural effusion treated?

A pleural effusion can be treated by removing fluid from the space between the tissues around the lungs. This is done with a needle that's put into the chest (thoracentesis). A small amount of the fluid may be sent to a lab to find out what is causing the buildup of fluid.

Removing the fluid may help to relieve symptoms, such as shortness of breath and chest pain. It can help the lungs to expand more fully.

If the pleural effusion doesn't get better, a catheter may be placed in the chest. This is a flexible tube that allows fluid to drain from the lungs. The catheter stays in the chest until the doctor removes it. Some people may get a treatment that removes the fluid and then puts a medicine into the chest cavity. This helps to prevent too much fluid from building up again.

A minor pleural effusion often goes away on its own.

Doctors may need to treat the condition that is causing the pleural effusion. For example, you may get medicines to treat pneumonia or congestive heart failure. When the condition is treated, the effusion usually goes away.

For a pleural empyema, the pus needs to be drained. It may drain from a flexible tube placed in the chest. Or you may have surgery to drain it. You also will get antibiotics.

Credits

Current as of: March 9, 2022

Author: Healthwise Staff
Medical Review:
E. Gregory Thompson MD - Internal Medicine
Adam Husney MD - Family Medicine
Hasmeena Kathuria MD - Pulmonology, Critical Care Medicine, Sleep Medicine

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