Pleural Effusion

Pleural Effusion is a condition in which there is an excessive amount of fluid in the space between the pleura and the chest cavity. The increased amount of fluid presses on the lungs, preventing them from expanding fully. Common symptoms of pleural effusion include coughing, chest pain, shortness of breath, or pain while breathing.

Normally, there is a small amount of fluid in the space between the pleura and the chest cavity to prevent the lungs from rubbing against the chest cavity during the expansion process of breathing. However, if this fluid is in excess, it will cause Pleural Effusion, which can be divided into 2 main types according to the cause of the increase in fluid volume:

• Transudate is caused by increased intravascular pressure or low blood protein levels, which causes fluid to leak into the pleural space. It is commonly found in patients with heart failure.
• Exudate is most often caused by inflammation, cancer, blocked blood vessels or lymphatic vessels, and tends to be more severe and difficult to treat than clear pleural effusion.

Symptoms of pleural effusion

Common symptoms of pleural effusion include:

• Shortness of breath, difficulty breathing when lying down or having difficulty taking a deep breath due to fluid in the pleural space pressing on the lungs, preventing the lungs from fully expanding.
• Dry cough and fever due to lung infection
• Continuous hiccups
• Chest pain

However, some patients may not show any symptoms indicating abnormalities, but may be found to have pleural effusion on an X-ray or physical examination.

Causes of pleural effusion

The two types of pleural effusion are often caused by different things, as follows:

The main causes of clear liquid

• Heart failure is a condition that results in venous back pressure, often resulting in fluid-filled swelling in the legs and possibly pleural effusion.
• Cirrhosis isa disease in which normal liver tissue is gradually replaced by scar tissue due to inflammation. This scar tissue interferes with the liver’s ability to filter wastes or expel toxins, as well as produce nutrients, hormones, and proteins in the blood. Low levels of protein in the blood cause fluid to leak out of the blood vessels and may lead to pleural effusion.
• Pulmonary embolism occurs when a blood clot from an organ (most commonly the leg) blocks the arteries that carry blood to the lungs (Pulmonary Artery). This causes chest pain, coughing, shortness of breath, sometimes pleural effusion , and can be life-threatening if not treated promptly. In addition to clear fluid, it can also cause cloudy fluid.
• After open heart surgery After opening the chest to operate on the heart muscle, heart valves or arteries within the heart, patients may be at risk for complications such as sudden cardiac death, cardiac arrhythmias, respiratory or kidney failure, chest pain, shortness of breath, and pleural effusion.

The main causes of cloudy liquids

• Pneumonia or cancer can cause the lungs and pleura to become inflamed, leading to the formation of fluid in the pleural space.
• Kidney failure is caused by damage to the kidneys, making them unable to filter blood and excrete urine properly. This can be acute kidney failure frominjury, exposure to toxins, or chronic kidney failure from high blood pressure and diabetes. People with kidney failure can develop complications such as chest pain, pleural effusion, muscle weakness, or permanent kidney damage.
• Inflammation may be inflammation in the lungs from the beginning or inflammation from other organs that results in pneumonia, leading to fluid in the pleural space, such as inflammation from arthritis, autoimmune disease( SLE ), etc.
• Other causes Diseases or conditions other than those listed above can also cause Pleural Effusion, but these are less common. These include tuberculosis, autoimmune diseases, blood clots in the chest, chylothorax, and people who are regularly exposed to asbestos.

Diagnosis of pleural effusion

Diagnosis of this condition can be done in several ways, including taking a medical history, performing a physical examination, taking an X-ray, or performing other additional tests. Details are as follows:

• A medical history and physical examination of those who have had heart failure or cirrhosis, along with symptoms such as chest pain, shortness of breath, dry cough, or abnormalities in the respiratory system on physical examination , may indicate pleural effusion.
• X-rays are a diagnostic method that provide clear results because they help show the characteristics of the lungs, including fluid in the pleural space.
• A computerized tomography (CT) scan may be used to further investigate possible causes of pleural effusion.
• Ultrasound is a procedure that uses high-frequency sound waves to create images of internal organs, such as soft tissue , fetus , and blood clots. Chest ultrasound is another method for diagnosing pleural effusion.
• Pleural Fluid Analysis can be performed in several ways, but most commonly, doctors use a pleural puncture or a small tube (tube) inserted into the lungs to drain the fluid, which is then examined.

Treatment of pleural effusion

Treatment for this condition depends on the cause and severity of the symptoms. However, most people are initially treated with drainage of fluid from the pleural space.

• Pleural drainage: The doctor makes a small incision and inserts a tube into the pleural space to drain the fluid outside the body. The patient may need to be repeated if the fluid level increases.
• Pleurodesis is a treatment that uses a thin substance to connect the pleura and chest cavity together. This is done after the fluid has been drained from the body to reduce the gaps and prevent the accumulation of fluid in the lungs. This procedure is most commonly used in cancer patients who also have pleural effusion.
• Surgery: This is usually done for people with severe symptoms. The doctor will insert a tube into the chest to direct fluid from the lungs into the abdomen, where the body can more easily drain fluid. Or, in severe cases, the doctor may remove part of the pleura, a procedure called a pleurectomy.

Complications of pleural effusion

If left untreated and not treated promptly, patients with Pleural Effusion may develop the following complications:

• Lung Scarring: Injuries to the pleura can cause the pleura to scar and thicken. Although minor scarring is usually not life-threatening, large scarring that causes abnormalities can require treatment and, if severe, a lung transplant may be recommended.
• Empyema is a condition in which pus forms in the space between the pleura and the chest cavity .
• Pneumothorax is a condition in which air leaks into the space between the pleura and the chest cavity. It can occur after a procedure to drain fluid from the pleural space, which prevents the lung from expanding properly.
• Blood Infection Patients who have a lung infection, bacteria from the lungs may enter the bloodstream and spread to other organs in the body. Blood Infectioncan be severe and even fatal if not treated promptly.

Prevention of pleural effusion

Pleural Effusion can be prevented by promptly treating any disease or abnormality that may be causing the fluid in the chest cavity or by undergoing a pleural fusion to reduce the space between the pleura and the chest cavity. In addition, changing certain behaviors, such as quitting smoking, can also help reduce the risk factors for cancer and heart disease, which are among the possible causes of pleural effusion.