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Home > Asbestos related diseases > Benign pleural diseases > Pleural effusion

Pleural effusion

The visceral pleura and the parietal pleura are two thin membranes in the chest, one lining the lungs, and the other covering the inside of the chest wall. Normally, a small amount of liquid is produced by small blood vessels in the pleural linings that lubricate the opposed pleural membranes to enable them to glide smoothly against one another while breathing. To maintain a balance extra liquid is moved away by blood and lymph vessels. An effusion is an excess of pleural fluid as a result of when something prevents fluid's removal or too much of it forms. The most common reasons are heart or lungs disease, and inflammation or infection of the pleura.

Pleural effusion - Excess liquid between the two membranes that circumscribe the lungs. These membranes are called the visceral and parietal pleurae. The visceral pleura bundles up around the lung and the parietal pleura lines the inside chest wall. A small quantity of liquid is spread thinly over the visceral and parietal pleurae (about 3 to 4 teaspoons) and plays the role of a lubricant between the two membranes. Pleural effusion is a significant increase in the quantity of pleural fluid.

The term "effusion" (from the Latin "effusio") is a pouring out. A pleural effusion means pouring out of liquid into the pleural space.

Alternative Names of Pleural effusion

Fluid in the chest; Pleural fluid

Pleural effusion is not a disease itself but usually a result of many other different diseases. That is why there is no "typical" victim in terms of sex, age, or other characteristics. Instead, anyone who evolves one of the conditions that can produce an effusion may be affected.

Many conditions are able to cause pleural effusion, including heart failure and uremia (kidney failure), hypoalbuminemia (low levels of albumin in the blood), infections (TB, bacterial, fungal, viral), pulmonary embolism, and malignancies (metastatic tumors, Hodgkin disease, mesothelioma). The causation of a pleural effusion is not ascertained in about 20% of cases, despite extensive analysis.

Our body produces pleural liquid in small amounts to lubricate the walls of the pleura, the thin membrane that surrounds the lungs and lines the chest hole. A pleural effusion is a significant collection of this fluid.

There are two types of pleural effusion: the transudate and the exudate. They are very different (what is very important), and which type is present points to what sort of disease is likely to have produced the effusion. It also can suggest the best approach to treatment.

Abnormal lung pressure causes transudative pleural effusions. Congestive heart failure is the most common reason.

Exudative effusions form is a result of inflammation (irritation and tumor) of the pleura. This is often originally from lung disease, such as lung cancer, pneumonia, tuberculosis and other lung infections, drug reactions, asbestosis, and sarcoidosis.

Liquid accumulating in the pleural space because of trauma or disease is pleural effusion. This can be a result of heart failure, cancer, pulmonary embolism, or inflammation. If blood is in the accumulating fluid, the condition is called "hemothorax"; if pus is there, it is called "empyema"; if air enters the space, it is called "pneumothorax"; and if there is chyle (milky fluid consisting of lymph and fat), it is called "chylothorax." There are two types of pleural effusion: transudative and exudative.

Transudative effusions originate from an imbalance between the venous-arterial pressure and the pressure within the pleural space (oncotic pressure). Transudates consists of few protein cells and little solid material content. It has a clear, pale yellow color. Transudative pleural effusion is caused by cardiac failure and, less commonly, liver and kidney disease cause.

Exudative effusions are caused by inflammation, infection, and cancer. Exudates contain a large amount of protein cells, white blood cells, and immune cells that have migrated into the pleural liquid and deposited in tissues or on tissue surfaces. They also are pale yellow but have a cloudy appearance. The fluid is yellow, cloudy, and has a foul odor if pus is present because of infection (empyema). Moreover, pneumonia, pulmonary embolism (blocked pulmonary artery), cancer, tuberculosis, and trauma are common causes of exudative pleural effusion.

Special types of pleural effusion

Some of the pleural disorders producing an exudate also can cause bleeding into the pleural space. Hemothorax is a condition when the effusion has in half or more of the number of red blood cells the blood itself. Chylothorax is when a pleural effusion has a milky appearance and contains a large amount of fat. Lymph liquid drains from tissues into a lymph vessels and finally accumulates in a large channel, the thoracic duct, running through the chest to empty into a major vein. Chylothorax is the result of chyle (this fluid), filtered out of the duct into the pleural space. Cancer in the chest is a same reason.

Symptoms of Pleural effusion

Chest pain and difficulty breathing (dyspnea) are the most usual symptoms. But significant amount of pleural effusions don't cause any symptoms and can be discovered only during the physical examination or found on a chest x-ray, which is the most convenient way to bear out the diagnosis.

Other symptoms

  • Shortness of breath
  • Chest pain, usually a sharp pain that is worse with cough or deep breaths
  • Cough
  • Hiccups
  • Rapid breathing
  • There may be no symptoms.

Diagnosis of Pleural effusion

The history and physical exam is usually used to confirm the diagnosis of pleural, and it is also seen on chest x-ray. Chest films are more sensitive from the lateral decubitus position (with the patient lying on their side), and can gather to 50 ml of liquid. But there should be at least 300 ml of liquid for upright chest films to pick up signs of pleural effusion (e.g., blunted costophrenic angles). If there is more than 500 ml, there are detectable clinical signs in the patient, such as dullness to percussion over the liquid, decreased movement of the chest on the affected side, diminished breath sounds on the affected side, pleural friction rub, decreased vocal fremitus and resonance, and egophony.

The cause of a pleural effusion must be determined. The process called thoracentesis means that pleural liquid is drawn out of the pleural space. In this case a needle should be inserted through the back of the chest wall into the pleural space.

Treatment of Pleural effusion

The best way of treating a pleural effusion is direct treatment at its origins, it's more effective than treating the effusion itself. In case of heart failure or a lung infection cured by antibiotics, the effusion will usually disintegrate. If the cause is not known, even after extensive analysis, or there is no effective treatment yet, the liquid can be taken away by inserting a large-bore needle or catheter into the pleural space, just as in diagnostic thoracentesis. This way of treatment can be repeated as often as is needed for better control of the quantity of liquid in the pleural space. A drug or material that irritates the pleural membranes can be used if large effusions still recur; it deliberately inflame them and make them to adhere close together (this is called sclerosis).

Prognosis of Pleural effusion

The effusion will reliably clear up and not recur if the reason of pleural effusion is found and effectively treated. In other cases, sclerosis will prevent significant effusions from recurring. Moreover, thoracentesis will make breathing easier, a large effusion causes a patient to be short of breath, and it may be repeated if needed. To a great extent, the primary cause of effusion determines the outlook for patients with pleural effusion and if it can be eliminated. There are some forms of pleural effusion, such as after abdominal surgery, that are only temporary and will pass away without specific treatment. If heart failure can be hindered, the patient will remain safe from pleural effusion.

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