Pleural effusion

Pleural effusion

Pleural effusion is the accumulation of fluid in the pleural cavity. This cavity is located between the pleural layer that wraps the lungs and the pleural layer that adheres to the inner wall of the chest cavity. This condition generally occurs as a result of disease complications, such as congestive heart failure and cirrhosis.

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

Causes of Pleural Effusion

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 effusion is caused by increased pressure in the blood vessels or low protein levels in the blood so that fluid leaks 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 as a result of inflammation, lung injury, tumor, or flow disruption in the lymph vessels. A number of diseases that are often the cause of this condition are:

  • Cancer, generally lung cancer or breast cancer
  • Pulmonary embolism
  • Lung infections, such as tuberculosis and pneumonia
  • Autoimmune diseases, such as lupus or rheumatoid arthritis
  • Injury to the chest wall, which causes bleeding or chylothorax

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

In addition, there are factors that can increase the risk of a person experiencing pleural effusion, namely:

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

Symptoms of Pleural Effusion

Most patients with pleural effusion do not experience symptoms. When symptoms appear, it depends on the medical condition that is the cause. For example, sufferers can experience complaints such as cough and high fever if the pleural effusion is caused by pneumonia.

Other common pleural effusion symptoms are:

  • Dry cough
  • Shortness of breath
  • Hiccup
  • Chest pain , especially when coughing and breathing
  • Difficulty breathing, especially when lying on your back (orthopnea)

When should you go to the doctor?

Immediately check with a doctor if you experience the symptoms of pleural effusion as mentioned above. That way, you can immediately get the right treatment and avoid complications.

You are also recommended to check yourself regularly with a doctor if you have ever 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 early treatment if necessary.

Diagnosis of Pleural Effusion

To diagnose pleural effusion, the doctor will ask questions about the patient's symptoms and health history, then continue with a physical examination of the chest . Further, the doctor will perform supporting examinations to confirm the diagnosis, such as:

  • Scanning with X-ray or CT scan, to check if there is a build-up of fluid in the lungs
  • Thoracentesis , to take a sample of fluid from the chest cavity and then examine it in the laboratory
  • Blood tests , to see signs of infection and check kidney function and liver function
  • Lung biopsy , to detect abnormal cells or tissues in the lungs
  • Echocardiography , to check the condition of the heart and detect disorders in the heart
  • Bronchoscopy , to check disorders in the respiratory tract

Treatment of Pleural Effusion

Pleural effusion treatment aims to remove fluid from the pleural cavity, prevent the recurrence of fluid accumulation, and overcome 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 in order to relieve the symptoms of shortness of breath and chest pain. This method is generally done in conjunction with the diagnosis process.

2. Chest tube

Chest tube is the installation of a catheter in the pleural cavity through a small incision in the chest. The catheter will be connected to a special device to remove fluid from the pleura. The duration of fluid production can last for several days so the patient needs to be treated in hospital.

3. Pleural drain

This procedure is similar to a chest tube , but the catheter is installed in the long term. That way, the patient can remove fluid from the pleura independently. A pleural drain is generally chosen when 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 cavity. This procedure is performed after the fluid in the pleural cavity is removed and is usually chosen when the pleural effusion often recurs.

5. Operation

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

Treatment of causes of pleural effusion

As mentioned above, pleural effusion can be caused by other conditions. To overcome it, the doctor can provide the following treatment:

  • Diuretics, for congestive heart failure
  • Antibiotic medicine , for lung infections, including pneumonia
  • Chemotherapy and radiation therapy, for cancer

Complications of Pleural Effusion

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

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

Prevention of Pleural Effusion

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

  • Limit the consumption of alcoholic beverages
  • Stop smoking
  • Use PPE ( personal protective equipment ) according to standards, when working with materials or substances that are potentially dangerous, such as asbestos
  • Carry out regular check-ups with the doctor according to the medical conditions you have, such as heart disease and autoimmune diseases
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