A pleural effusion is an accumulation of fluid between the layers of the membrane that lines the lungs and chest cavity.

Alternative Names

Fluid in the chest; Pleural Fluid

Causes, incidence, and risk factors

Pleural fluid is normally formed in small amounts to lubricate the surfaces of the "pleura," which is the thin membrane that lines the chest cavity and surrounds the lungs. A "pleural effusion" is an abnormal collection of this fluid. Two different types of effusions can develop. Transudative pleural effusions are usually caused by a disorder in the normal pressure present in the lung. Congestive heart failure is the most common cause of transudative effusion. Exudative effusions form as a result of inflammation (irritation and swelling) of the pleura, which is often caused by lung disease. Cancer , pneumonia, tuberculosis and other lung infections, drug reactions, collagen-vascular diseases, asbestosis , and sarcoidosis are some diseases that can cause exudative pleural effusions. The cause and type of pleural effusion can usually be determined by taking a sample of the fluid by thoracentesis (removing fluid via a needle inserted between the ribs into the chest cavity, using a local anesthetic).

Signs and tests

During a physical examination, the doctor will listen to the sound of your breathing with a stethoscope and may tap on your chest to listen for dullness. The following tests may help to confirm a diagnosis:

Chest X-ray

Thoracic CT

Ultrasound of the chest

Thoracentesis

Pleural fluid analysis

Treatment

Treatment may be directed at removing the fluid, preventing its re-accumulation, or addressing the underlying cause of the fluid buildup.

Therapeutic thoracentesis may be done if the fluid collection is large and causing pressure or shortness of breath . Treatment of the underlying cause of the effusion then becomes the goal. For example, pleural effusions caused by congestive heart failure are treated with diuretics and other medications that treat heart failure. Pleural effusions caused by infection are treated with antibiotics specific to the causative organism. In patients with cancer or infections, the effusion is often treated by using a chest tube to drain the fluid. Chemotherapy , radiation therapy , or instilling medication within the chest that prevents re-accumulation of fluid after drainage may be used in some cases.

Expectations (prognosis)

The expected outcome depends upon the underlying disease.

Complications

A lung surrounded by a fluid collection for a long time can collapse.

Pleural fluid that becomes infected can become an abcess, called an empyema, that requires prolonged drainage with a catheter, called a chest tube, that is placed into the fluid collection.

Pneumothorax

(air within the chest cavity) can be a complication of the

thoracentesis procedure.

Calling your health care provider

Call your health care provider if symptoms suggestive of pleural effusion develop. Call your health care provider or go to the emergency room if shortness of breath or difficulty breathing occurs immediately after thoracentesis .