Excess fluid in the pleural cavity, called pleural effusion, can cause symptoms such as shortness of breath and chest pain. Causes include pneumonia, cancer, heart failure, and blood clots. Diagnosis is confirmed through imaging tests and treatment varies depending on the amount of fluid present, ranging from no treatment to surgical removal. The underlying medical condition must also be treated to prevent recurrence.
Two membranes called the pleurae surround the lungs. A pleura covers the lung itself and a second membrane is attached to the chest wall. The pleural cavity is the space between the two membranes. Although the fluid is normally in the pleural cavity, if it is present in excess it is called a pleural effusion.
There are various causes of pleural effusion. The most common causes are pneumonia and some types of cancer, such as lung cancer. Other causes include heart failure and a pulmonary embolism, which is a blood clot in the lung.
A pleural effusion can cause a variety of symptoms depending on the amount of excess fluid in the pleural cavity. If the effusion is small, such as less than 300ml, there may be no symptoms. Larger spills can cause symptoms, such as shortness of breath, a dry cough, and chest pain.
In addition to the symptoms, there are physical findings during a physical exam. A doctor will hear a decrease in lung sounds in the affected area of the lung. A pleural rub, which is a grinding sound heard in the chest, is also usually present.
Tests that confirm a pleural effusion diagnosis include a chest X-ray, computed tomography (CT) scan, or chest ultrasound. Occasionally, one of the above tests won’t be able to accurately diagnose a pleural effusion, and a more invasive test called a thoracoscopy will be needed. This is a surgical procedure, in which the pleurae can be visualized.
Treatment for a pleural effusion can vary depending on the amount of fluid in the pleural cavity. A small effusion, which does not cause any symptoms, may not require immediate treatment. If the effusion causes breathing problems, a thoracentesis may be done. A needle is inserted into the pleural cavity and the fluid is drained. A thoracentesis may also be done in small effusions to analyze pleural fluid and help diagnose disease.
In very large pleural effusions, especially where infection is suspected, a thoracotomy may be performed. This surgical procedure removes fluid from the pleural cavity and also removes any infected tissue. Chest tubes are usually inserted into the pleural space for a few days to allow residual fluid to drain.
Most pleural effusions can be treated and symptoms improve. Although the effusion must be treated, the underlying medical condition that caused the effusion must also be treated. Without treatment for the underlying condition, it is possible for the effusion to return.
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