Pleural Effusion

Mon, 22 Jan 2024

Pleural Effusion

Pleural effusion is excess fluid that accumulates between the two pleural layers, the fluid-filled space that surrounds the lungs. Excessive amounts of such fluid can impair breathing by limiting the expansion of the lungs during ventilation.

Pleural Effusion (Fluid in the Lungs) is a condition with an abnormal collection of fluid in the Chest Cavity. The pleura is a thin membrane that lines the surface of the lungs and the inside of the chest wall outside the lungs. In pleural effusions, fluid accumulates in the space between the layers of pleura.

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Excessive fluid may accumulate because the body does not handle fluid properly (such as in heart failure, or kidney and liver disease). The fluid or water in pleural effusions also may result from inflammation, such as in Pneumonia, Tuberculosis and many other conditions. In our country, Pneumonia and Tuberculosis are two of the commonest causes of Pleural Effusion.

Pleural Effusion Causes

• CHF: Pleural effusion is frequently caused by congestive heart failure (CHF). As a result of the hearts inability to pump blood efficiently, the chest and lungs fill with fluid.
• Illnesses: A number of illnesses, including pneumonia and TB, can inflame the pleura and lead to the accumulation of fluid.
• Cancer: Pleural effusion can be caused directly or indirectly by malignancies, including lung, breast, and lymphoma cancer.
• Liver and Kidney Disease: Illnesses including cirrhosis and nephrotic syndrome throw off the bodys fluid balance, which might lead to pleural effusion.
• Pulmonary Embolism: Blood clots that form in the lungs can restrict blood flow and cause fluid to build up in the pleural space.

Symptoms of Pleural Effusion

The most common symptom of pleural effusion is shortness of breath or difficulty in breathing. As the effusion grows larger the more difficult it is for the person to breathe. Chest pain is also a symptom of pleural effusion and occurs because the pleural lining of the lung is irritated. The pain is usually described as a sharp pain, worsening with a deep breath. The commonest cause of Pleural Effusion in our country is tuberculosis however, it can occur due to tumors (cancers) and numerous other causes also.

• People may have trouble breathing, particularly when theyre resting flat.
• Chronic, dull, or agonizing chest discomfort that is frequently made worse by heavy breathing or coughing.
• A persistent cough that occasionally produces little or no sputum.
• Fever and chills may appear when an infection is the root cause.
• Reduced lung function may cause weariness and an overall feeling of weakness.

Initially, Pleural effusions may not cause any symptoms. Later on, as the amount of fluid increases it can cause symptoms like:

• Shortness of breath
• Pain in the Chest
• Cough
• Fever

Note- In case of persistence symptoms consult your expert and get the expert advice.

Diagnosis

The diagnosis is made by the analysis of the fluid aspirated from the chest. If inconclusive it can be repeated two or three times.

• Physical Examination: During a physical examination, medical professionals could notice diminished breath sounds.
• Imaging: The existence and size of pleural effusion can be determined by chest X-rays or more thorough CT scans.
• Thoracentesis: A diagnostic process in which pleural fluid is drawn out and analyzed to ascertain the underlying reason.

Pleural Effusions can be diagnosed by following investigations:

• Chest X-ray film
• Ultrasound
• CT SCAN

Treatment of Pleural Effusion

However, if the aspiration is inconclusive and fails to provide an answer, key-hole visualization of inside of the chest (diagnostic thoracoscopy) is the procedure of choice and provide the answer in almost all of the cases.

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The Treatment of pleural Effusion primarily depends on the cause: Aim of treating pleural effusion is to treat the cause effectively. Hence pleural effusion due to pneumonia is treated with antibiotics. Pleural Effusion due to tuberculosis is treated with Anti-tubercular Medicines.

 When the amount of pleural fluid is large and causing breathlessness, drainage of the fluid (Thoracentesis) is done to improve breathing. If it recurs again & again, a chest tube (or a pig tail catheter) may be inserted. Sometimes, the fluid becomes "Pus" and form a layer around the collapsed lung of forms multiple septations in the pus. 

This condition is now called "Empyema" (Pus around the Lungs) and need "Decortication" procedure. In this, we remove the thick layer (peel) from around the lung, thereby freeing it up to expand fully. Simultaneously, all the septations are broken, thorough wash is done to clear any infectious material and fresh chest tube is put under vision to drain any re-collection.

Traditionally, this procedure i.e. Decortication is done by Open method which involves cutting muscles & ribs resulting in weeks to months to recovery. We at Centre for Chest Surgery do the "SAME" procedure by Key-hole (VATS) Surgery where the whole procedure is carried out by 2-3 cm size holes, with no cutting of muscles or ribs. Patients have much "less pain" and blood loss and recover much faster, mostly back to work in few weeks, apart from cosmetically better outcome.

Sometimes the fluid accumulates due to involvement of pleura by cancer. In such cases, we drain the fluid by Chest tube to complete Lung expansion & put some chemicals (Pleurodesis) to fuse the pleural layers to prevent recurrence of pleural effusion.

In order to reduce symptoms, enhance lung function, and address the underlying cause of pleural effusion, fast and proper treatment is necessary. The etiology, the degree, and the patients general health prior to the existing condition, all play a role in the treatment.

• Treating the Underlying Cause: Treating the underlying cause is essential for effective pleural effusion therapy. Antibiotics or antifungal medications are used to treat effusions brought on by infections. Congestive heart failure cases are treated with medicine that promotes heart health. When cancer is the cause, extensive treatments are used to treat the underlying malignancy. 
• Thoracentesis: The doctor can advise thoracentesis if an effusion creates pain or breathing problems. To drain the collected fluid, a needle or catheter must be inserted into the pleural area. In addition to relieving symptoms, it makes pleural fluid investigation possible in order to identify the underlying reason.
• Medicines: These assist the body in getting rid of extra fluid, which is useful when renal or heart problems are a factor in the effusion.
• Pleurodesis: In situations when fluid buildup is ongoing or recurring, pleurodesis may be an option. In this technique, an irritating material (like talc) is injected into the pleural cavity to cause the pleura to stick to one another and stop additional fluid accumulation.
• Pleural Drainage Catheter: A medical professional may put a catheter into the pleural area to drain fluid continuously. Patients may take care of effusion in their homes by draining fluid as necessary thanks to this.
• Surgical Interventions: Surgical operations such as a pleurectomy (removal of a portion of the pleura) or decortication (removal of the outermost layer of the lung) may be required to treat pleural effusion in severe or complicated instances or when other therapies fail.

Minimally Invasive Key-Hole (VATS) Surgery for Pleural Effusion

Pleural effusion can be treated using a minimally invasive procedure called video-assisted thoracoscopic surgery (VATS). Small incisions are made using this method, and tiny cameras and surgical instruments are introduced. Compared to open surgery, VATS has a number of benefits, including less discomfort, less time in the hospital, and quicker recovery. 

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Using VATS, the surgeon may see the pleural space clearly, find the source of the effusion, and carry out operations like drainage or pleurodesis. When treating recurring pleural effusion or if a certain diagnosis is required, this minimally invasive technique is very beneficial. An accurate, patient-friendly method of treating problems associated with pleural effusion is VATS surgery.

Pleural effusion must be thoroughly evaluated by a medical specialist in order to pinpoint the underlying reason and choose the best course of therapy. A patients entire health and quality of life can be considerably enhanced by prompt and effective therapy.

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