A pleural effusion is a buildup of fluid between the lungs and in the chest wall. It causes difficulty breathing because the lungs cannot expand to their normal extent when you breathe. Pleural effusion is a symptom of several diseases.
What is a pleural effusion?
Pleural effusion is an accumulation of fluid in the pleural space. The lungs and the inner wall of the chest are lined with the pleura (pleura). This is a thin layer of skin that is necessary for the lungs to expand and slide along the wall of the chest when you breathe. Normally, there is a very small amount of fluid between the pleural sheets of the lungs and the chest. However, various diseases cause this fluid to increase and accumulate in the pleural space. Depending on the disease, the fluids have a different composition. A distinction is made between bloody pleural effusion (hemathotorax) and serous pleural effusion (serothorax), where “serous” means that the consistency of the fluid is similar to that of blood serum. Furthermore, there is purulent pleural effusion (pyothorax) and pleural effusion with lymphatic fluid (chylotorax). Thorax is the medical term for chest.
Causes
Each type of pleural effusion is caused by different diseases. The most common trigger is congestive heart failure, a chronic or acute heart failure, which can lead to serothorax. Also, pleurisy or malignant tumors can cause serothorax. In the case of bloody pleural effusion, an injury is usually the cause; very rarely, it forms when the pleura is affected by a tumor. If the fluid is purulent, it is usually due to bacterial pneumonia that is already well advanced. If the effusion consists of lymph fluid, there may be a lymph node disease that prevents the drainage of the lymph, so that it accumulates in the pleural cavity. This occurs, for example, in leukemia. Other diseases that can cause pleural effusion include breast cancer, ovarian cancer, lung cancer and kidney cancer. This can cause shortness of breath, abnormal breathing sounds, difficulty breathing, and trepidation. However, fever and chest pain are also not uncommon.
Diseases with this symptom
- Heart failure
- Pleurisy
- Liver failure
- Tuberculosis
- Hodgkin’s disease
- Pneumonia
- Leukemia
- Kidney cancer
- Pleural mesothelioma
- Pulmonary embolism
- Breast cancer
- Ovarian cancer
- Lung cancer
- Pancreatitis
- Chylothorax
Diagnosis and course
The main symptom of pleural effusion is difficulty breathing. However, they occur only when a larger amount of fluid has already accumulated. Smaller effusions are often not even noticed by affected individuals. The pleural effusion forms slowly and only gradually will the patient experience shortness of breath and possibly pain, especially on exertion. In addition, there are always the symptoms of the triggering disease. The physician can already recognize a suspicion of pleural effusion by listening to the breathing sounds, as well as by tapping the chest. An ultrasound examination (sonography), which clearly shows the fluid, provides certainty for the diagnosis. X-rays and a computed tomography scan may also be used to confirm the diagnosis. To infer the underlying disease from the pleural effusion, the physician must take a sample of the fluid. This is done by a pleural puncture, in which a cannula is used to remove some of the fluid from the pleural space and then it is examined.
Complications
The main complication of pleural effusion that can be seen is pleural calluses. These can occur both when the pleural effusion has been treated by a doctor and when no treatment is given. The so-called pleural calluses are scarring adhesions of the pleural sheets. In most cases, the pleural calluses are also thickened. If the pleural effusion occurs as a result of pnuemonia (pneumonia), it may also become infected. This is also a possible complication of pleural effusion. An infected pleural effusion is technically called a “complicated pleural effusion”. Furthermore, there is a risk that the infected pleural effusion will ulcerate. If such a purulent infection is present, it is referred to as a pleural empyema.If the patient receives timely medical treatment, the risk of complications occurring is lower. In the context of the shortness of breath that occurs as a symptom of pleural effusion, there may also be other complications or complaints. Here, for example, anxiety occurring in the patient should be mentioned, which often occurs as a result of severe shortness of breath. In addition, care should be taken to ensure that the patient breathes deeply despite the pain caused by the pleural effusion. Failure to do so may result in subsequent infection of the lungs, if one is not already present.
When should you see a doctor?
A doctor should always be consulted in the event of a pleural effusion. This condition can lead to serious complications if left untreated, and for this reason should always be examined and treated by a doctor. As a rule, a doctor should be consulted if the pleural effusion causes breathing difficulties or shortness of breath. Medical advice should also be sought if the body is less able to withstand stress or if fatigue persists. The breathing difficulties may lead to loss of consciousness. If these symptoms are very severe or the person concerned loses consciousness, an emergency doctor may also be called. Likewise, if the pleural effusion leads to pneumonia, medical treatment must be sought. This is a very serious condition for the body and can lead to death if left untreated. In this case, this inflammation makes itself felt through pain when breathing. The patient can also consult a doctor in case of panic attacks or sweating due to breathing difficulties. In this case, the patient can also consult a psychologist. With early diagnosis and therapy, most complaints can be well limited.
Treatment and therapy
Treatment of pleural effusion depends on its causes. If a large amount of fluid has already accumulated so that breathing is impeded, the physician will puncture the pleural space one or more times to reduce the effusion. This measure already provides relief from the acute symptoms. If new fluid forms repeatedly and very quickly, it is possible to insert a chest drain. For this purpose, a so-called drainage tube is placed permanently in the pleural cavity, usually through a small incision in the skin, and guided outward so that newly formed fluid can drain off again. In addition, the underlying disease must be treated in all cases. In the course of this treatment, the pleural effusion can be favorably influenced by physical measures. Chest compresses, respiratory gymnastics or heat radiation, for example, are helpful. One surgical option is thoracoscopy. It is used when bacterial infections have triggered the pleural effusion and have led to severe adhesions and suppurations in the pleura. It involves an endoscopic procedure to remove the adhesions so that the lungs can recover quickly. If the underlying disease cannot be treated, pleurodesis is still an option. In this procedure, the pleura of the lung and pleura are selectively glued together by inserted drugs so that fluid can no longer accumulate there.
Outlook and prognosis
Usually, a pleural effusion results in breathing difficulties. These can have a negative impact on health and lead to panic attacks in many patients. In most cases, morbid and loud breathing sounds also occur, so the disease can be relatively well diagnosed. Often the symptom also leads to pneumonia, which in an untreated state can become life-threatening for the patient. Most of those affected suffer from acute shortness of breath. This does not have to be permanent, but can be very disturbing and unpleasant, especially in stressful situations or when sleeping. It is usually also not possible for the patient to perform physical activities, which greatly reduces the quality of life. In the case of a pleural effusion, the initial treatment is aimed at relieving the symptoms and does not cause any further discomfort. After that, however, the underlying disease must be treated. This usually requires endoscopic surgery and the use of medication. Life expectancy is not reduced as long as treatment of pleural effusion is performed early.
Prevention
Pleural effusion cannot be specifically prevented because it is caused by disease.However, if one experiences breathing difficulties when certain diseases exist, it is recommended to have the causes clarified as soon as possible so that any existing pleural effusion can be treated in a timely manner.
What you can do yourself
To ensure the success of treatment and prevent any consequences (such as fibrothorax or pneumonia), it is advisable to perform respiratory therapy exercises several times a day on your own. First of all, a physiological breathing rhythm should be trained. To do this, the patient places both hands on his abdomen. Now deep breaths are taken through the nose. At the same time, an attempt is made to direct the air under one’s own hands into the abdomen. Then the exhalation through the mouth takes about twice as long as the inhalation. A short pause in breathing now follows, which automatically makes the next breath deeper. This is repeated about five to six times. To prevent dizziness from the high oxygen intake, a short pause is then taken with shallow, normal breaths. If this works well, the position of the hands, and thus the direction of breathing, can be varied (for example, to the flanks or under the sternum to improve the mobility of the chest). This exercise improves the elasticity and ventilation of the lungs. To further increase oxygenation, the pause between inhalation and exhalation can be shifted. For example, in the so-called 4-7-8 method, the patient counts to four in their mind while inhaling, then holds their breath while counting to seven (this gives the organism more time for gas exchange at the alveoli, the air sacs in the lungs), and exhales while counting to eight. This is also repeated five to six times. Furthermore, there exists a wide range of breathing trainers (for example, the Triflo) that can positively influence recovery.
