Pleural Effusion Causes, Signs & Treatment

Pleural effusion, sometimes referred to as “water on the lungs,” is the build-up of

excess fluid between the layers of the pleura outside the lungs. The pleura are thin
membranes that line the lungs and the inside of the chest cavity and act to lubricate
and facilitate breathing. Normally, a small amount of fluid is present in the pleura.

The seriousness of the condition depends on the primary cause of pleural effusion,
whether breathing is affected, and whether it can be treated effectively. Two factors
that must be considered are treatment for associated mechanical problems as well
as treatment of the underlying cause of the pleural effusion.

The symptoms of pleural effusion

• Chest pain
• Dry, nonproductive cough
• Dyspnea (shortness of breath, or difficult, labored breathing)
• Orthopnea (the inability to breathe easily unless the person is sitting up
straight or standing erect)

The causes of pleural effusion

Depending on the cause, the excess fluid may be either protein-poor (transudative)
or protein-rich (exudative).

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

include:

• Heart failure
• Pulmonary embolism
• Cirrhosis
• Post open heart surgery
Exudative (protein-rich fluid) pleural effusions are most commonly caused by:

• Pneumonia
• Cancer
• Pulmonary embolism
• Kidney disease
• Inflammatory disease

Other less common causes of pleural effusion include:

• Tuberculosis
• Autoimmune disease
• Bleeding (due to chest trauma)
• Chylothorax (due to trauma)
• Rare chest and abdominal infections
• Asbestos pleural effusion (due to exposure to asbestos)
• Meig’s syndrome (due to a benign ovarian tumor)
• Ovarian hyperstimulation syndrome

Certain medications, abdominal surgery and radiation therapy may also cause
pleural effusions. Pleural effusion may occur with several types of cancer including
lung cancer, breast cancer and lymphoma. In some cases, the fluid itself may be
malignant (cancerous), or may be a direct result of chemotherapy.

The tests most commonly used to diagnose and evaluate pleural effusion
include:

• Chest x-ray
• Computed tomography (CT) scan of the chest
• Ultrasound of the chest
• Thoracentesis (a needle is inserted between the ribs to remove a biopsy, or
sample of fluid)
• Pleural fluid analysis (an examination of the fluid removed from the pleura
space)

Management and Treatment

• Treatment of pleural effusion is based on the underlying condition and

whether the effusion is causing severe respiratory symptoms, such as
shortness of breath or difficulty breathing.
• Diuretics and other heart failure medications are used to treat pleural effusion
caused by congestive heart failure or other medical causes. A malignant
effusion may also require treatment with chemotherapy, radiation therapy or a
medication infusion within the chest.
• A pleural effusion that is causing respiratory symptoms may be drained using
therapeutic thoracentesis or through a chest tube (called tube thoracostomy).
• For patients with pleural effusions that are uncontrollable or recur due to a
malignancy despite drainage, a sclerosing agent (a type of drug that
deliberately induces scarring) occasionally may be instilled into the pleural
cavity through a tube thoracostomy to create a fibrosis (excessive fibrous
tissue) of the pleura (pleural sclerosis).
 • Pleural sclerosis performed with sclerosing agents (such as talc, doxycycline,
and tetracycline) is 50 percent successful in preventing the recurrence of
pleural effusions.

Surgery

Pleural effusions that cannot be managed through drainage or pleural sclerosis may
require surgical treatment.

The two types of surgery include:

Video-Assisted Thoracoscopic Surgery (VATS)

A minimally-invasive approach that is completed through 1 to 3 small (approximately

½ -inch) incisions in the chest. Also known as thoracoscopic surgery, this procedure
is effective in managing pleural effusions that are difficult to drain or recur due to
malignancy. Sterile talc or an antibiotic may be inserted at the time of surgery to
prevent the recurrence of fluid build-up.

Thoracotomy (Also referred to as traditional, “open” thoracic surgery)

A thoracotomy is performed through a 6- to 8-inch incision in the chest and is

recommended for pleural effusions when infection is present. A thoracotomy is
performed to remove all of the fibrous tissue and aids in evacuating the infection
from the pleural space. Patients will require chest tubes for 2 days to 2 weeks after
surgery to continue draining fluid.