Management Team

Pleural effusion

Overview

Pleural effusion is the accumulation of excess fluid between the layers of the pleura, the thin membranes that line the lungs and the inside of the chest cavity.

Pleural effusion can be caused by various conditions, which can be broadly classified into transudative and exudative effusions:

Transudative Effusions:

  • Heart failure: Increased pressure in the heart and blood vessels
  • Cirrhosis: Reduced plasma oncotic pressure due to low albumin levels
  • Nephrotic syndrome: Low protein levels in the blood

Exudative Effusions:

  • Infections: Such as pneumonia or tuberculosis
  • Malignancies: Lung cancer, metastatic cancers
  • Pulmonary embolism: Blood clot in the lungs
  • Inflammatory conditions: Rheumatoid arthritis, lupus
  • Trauma: Injury to the chest

  • Dyspnoea (shortness of breath)
  • Chest pain: Often sharp and may worsen with deep breaths
  • Cough: Often dry may be productive
  • Fever: If the effusion is due to an infection
  • Hiccups: Due to irritation of the diaphragm

Clinical Examination: Decreased breath sounds, dullness to percussion and reduced tactile fremitus.

Imaging Studies:

  • Chest X-ray: Can show fluid in the pleural space.
  • Ultrasound: More sensitive for detecting small effusions and guiding thoracentesis.
  • CT Scan: Provides detailed images and helps identify the underlying cause.

Thoracentesis: Involves inserting a needle into the pleural space to withdraw the pleural fluid, which is then histopathologically analysed to determine the cause of the effusion and provide symptomatic relief to the patient.

  • Antibiotics: For bacterial infections.
  • Diuretics: For heart failure.
  • Chemotherapy/Radiation: For malignancies.
  • Antitubercular treatment: For TB.
  • Pleurodesis: A procedure to adhere the pleural layers together, preventing fluid reaccumulation. Often used in recurrent effusions, particularly due to malignancies.
  • Surgery
  • Pleurectomy: Removal of part of the pleura.
  • Indwelling Pleural Catheter: For periodic drainage of the pleural fluid.
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