Pleural Effusion, Causes, Diagnosis, Treatment, Prevention, Complications

Pleural effusion is a buildup of fluid in the pleural cavity. This cavity is located between the pleural layer that covers the lungs with the pleural layer that attaches to the inner wall of the chest cavity. This condition generally occurs due to complications of the disease, such as congestive heart failure and cirrhosis.

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Pleural Effusion, Causes, Diagnosis, Treatment, Prevention, Complications

Under normal conditions, there is about 10 ml of fluid in the pleural space. This fluid functions as a lubricant, so that the lungs move smoothly when breathing. However, in pleural effusion, this amount of fluid can accumulate because too much or even only a little fluid comes out of the pleural space.

Pleural Effusion Causes

Based on the cause, pleural effusion is divided into transudative pleural effusion and exudative pleural effusion. Here is the explanation:

Transudative pleural effusion

Transudative pleural effusions are caused by increased pressure in the blood vessels or low levels of protein in the blood so that fluid seeps into the pleura. This condition can be caused by a number of the following diseases:

Congestive heart failure
Liver cirrhosis
Cancer, such as mesothelioma
Pulmonary embolism
Hypoalbuminemia
Kidney disorders, such as nephrotic syndrome

Exudative pleural effusion

This pleural effusion occurs due to inflammation, lung injury, tumor, or obstruction of the flow of lymph vessels. A number of diseases that often cause this condition are:

Cancer, usually lung cancer or breast cancer
Pulmonary embolism
Infections of the lungs, such as tuberculosis and pneumonia
Autoimmune diseases, such as lupus or rheumatoid arthritis
Injury to the chest wall, which causes bleeding or a chylothorax

Although rare, pleural effusions can also be caused by other conditions, such as consumption of certain drugs, including chemotherapy drugs, surgery on the stomach or chest, and radiation therapy.

In addition, there are factors that can increase a person's risk of having a pleural effusion, namely:

Suffer from hypertension (high blood pressure)
Have a smoking habit
Consuming alcoholic beverages too often
Exposure to asbestos dust for a long time

Pleural Effusion Symptoms

Most people with pleural effusion have no symptoms. If symptoms appear, it depends on the medical condition that is the cause. For example, sufferers may experience complaints such as coughing and high fever if the pleural effusion is caused by pneumonia.

Other common symptoms of pleural effusion are:

Dry cough
Hard to breathe
Hiccup
Chest pain, especially when coughing and breathing
Difficulty breathing, especially when lying on your back (orthopnea)

When to see a doctor

Immediately do an examination to the doctor if you experience symptoms of pleural effusion as mentioned above. That way, you can immediately get the right treatment and avoid complications.

You are also advised to check yourself periodically to the doctor if you have been diagnosed with pleural effusion or suffer from a disease that has the potential to cause this condition. Thus, the doctor can monitor your condition and provide earlier treatment if needed.

Diagnosis of pleural effusion

To diagnose pleural effusion, the doctor will conduct a question and answer about the patient's symptoms and medical history, then proceed with a physical examination of the chest. Furthermore, the doctor will carry out supporting examinations to confirm the diagnosis, such as:

Scanning with X-rays or CT scans, to check whether there is a buildup of fluid in the lungs
Thoracentesis, to take fluid samples from the chest cavity and then examine them in the laboratory
Blood tests, to look for signs of infection and check kidney function and liver function
Lung biopsy, to detect abnormal cells or tissue in the lungs
Echocardiography, to check heart conditions and detect heart problems
Bronchoscopy, to check for obstructions in the respiratory tract

Pleural Effusion Treatment

Treatment of pleural effusion aims to remove fluid from the pleural cavity, prevent recurrence of fluid buildup, and address the cause. Treatment methods that can be done include:

1. Thoracentesis

Thoracentesis is performed by inserting a needle into the chest cavity to collect excess fluid to relieve symptoms of shortness of breath and chest pain. This method is generally performed in conjunction with the diagnostic process.

2. Chest tubes

A chest tube is a catheter placed in the pleural cavity through a small incision in the chest. The catheter will be connected to a special tool to remove fluid from the pleura. The duration of discharge can last for several days so the patient needs to be hospitalized.

3. Pleural drain

This procedure is similar to a chest tube, but the catheter is in place long term. That way, the patient can remove fluid from the pleura independently. Pleural drain is generally chosen if fluid continues to accumulate even though it has been removed.

4. Pleurodesis

Pleurodesis is the procedure of injecting an inflammatory substance, such as talc or doxycycline, into the pleural space. This procedure is performed after the fluid in the pleural cavity is removed and is usually chosen when the pleural effusion recurs frequently.

5. Operation

Surgery can be performed if the method of removing fluid from the pleural cavity is not effective. The operation is performed by removing the tissue in the chest cavity that is suspected of causing the pleural effusion. There are two methods of surgery that can be performed, namely thoracoscopy or thoracotomy.

Treatment of the cause of pleural effusion

As mentioned above, pleural effusions can be caused by other conditions. To overcome this, doctors can provide the following treatments:

Diuretic drugs, for congestive heart failure
Antibiotics, for pulmonary infections, including pneumonia
Chemotherapy and radiation therapy, for cancer

Pleural Effusion Complications

If not treated immediately, pleural effusion can cause serious complications, such as:

Atelectasis
Sepsis
Empyema
Pneumothorax
Thickening of the pleura and the appearance of scar tissue in the lining of the lungs

Pleural Effusion Prevention

Pleural effusion can be prevented by avoiding the underlying medical condition. A number of efforts that can be made are:

Limit consumption of alcoholic beverages
Stop smoking habit
Use PPE (personal protective equipment) according to standards, when working with potentially hazardous materials or substances, such as asbestos
Carry out periodic checks with a doctor according to medical conditions you have, such as heart disease and autoimmune diseases

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