Pleural Effusion (PE)
Pleural Effusion (PE): Overview, Causes, Symptoms, and Treatment
What is Pleural Effusion?
Pleural effusion is the abnormal accumulation of fluid in the pleural space—the thin cavity between the lungs and chest wall. Normally, a small amount of lubricating fluid exists here to facilitate lung movement during breathing. When excess fluid builds up, it can compress the lung, impairing breathing and causing symptoms.
Types of Pleural Effusion
- Transudative Effusion:
- Protein-poor fluid resulting from systemic conditions like heart failure, cirrhosis, or kidney disease that cause imbalance in pressure or low blood protein levels.
- Exudative Effusion:
- Protein-rich fluid caused by local inflammation, infection, malignancy, or injury affecting the pleura, such as pneumonia, tuberculosis, or cancer.
Causes of Pleural Effusion
Common causes include:
- Heart failure (most frequent cause)
- Liver cirrhosis or kidney disease
- Infections: pneumonia, tuberculosis
- Cancer: lung, breast, or metastatic cancers
- Autoimmune diseases: rheumatoid arthritis, lupus
- Pulmonary embolism
- Ruptured esophagus
- Medications: methotrexate, amiodarone
- Radiation therapy
- COVID-19
Symptoms
- Many people are asymptomatic, especially with small effusions.
- Larger effusions can cause:
- Shortness of breath
- Chest pain, especially when breathing deeply (pleuritic pain)
- Cough
- Fever (if infection is present)
In some cases, patients may experience chest tightness or a feeling of heaviness.
Diagnosis
- Physical Exam: decreased breath sounds, dullness to percussion.
- Imaging: Chest X-ray, ultrasound, or CT scan to confirm fluid presence and estimate size.
- Thoracentesis: Needle aspiration of pleural fluid for analysis.
- Pleural Fluid Analysis:
- Differentiates transudate vs. exudate (using Light’s criteria).
- Tests for infection, malignancy, or other causes.
- Additional Tests: Blood tests, microbiology, cytology, and sometimes biopsy.
Treatment
- Address underlying cause: heart failure, infection, cancer, etc.
- Drainage:
- Thoracentesis for symptomatic relief or diagnostic purposes.
- Chest tube placement for large or recurrent effusions, especially if caused by infection or malignancy.
- Medications:
- Antibiotics for infections.
- Diuretics for heart failure-related effusions.
- Chemotherapy or radiotherapy for malignant effusions.
- Surgical options:
- Pleurodesis to prevent recurrent effusions in malignant or recurrent cases.
- Surgery (VATS or thoracotomy) in complex cases.
Prognosis
Depends on the underlying cause. Many effusions resolve with appropriate treatment, but malignant or chronic effusions may require ongoing management. Early diagnosis and treatment improve outcomes.
Summary
Pleural effusion is a common condition caused by various systemic, infectious, or malignant diseases. Proper diagnosis through imaging and fluid analysis guides targeted therapy, which may include drainage, medication, or surgery. Managing the underlying cause is crucial for effective treatment and improved quality of life.
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References:1 Cleveland Clinic: Pleural Effusion2 Penn Medicine: Pleural Effusion Symptoms and Causes3 WebMD: Causes, Symptoms, and Treatments of Pleural Effusion4 Medical News Today: Causes and Treatment of Pleural Effusion5 Patient.info: Causes and Symptoms of Pleural Effusion
