Pleural Effusion: Fluid Around the Lung, Symptoms and Next Steps

What it involves

The MedlinePlus encyclopedia explains that a pleural effusion is a buildup of fluid between the layers of tissue that line the lungs and the chest cavity. The body normally makes a small amount of this fluid to lubricate the lining, called the pleura, and a pleural effusion is an abnormal, excessive collection of it.

Who this is for

• Adults with sharp chest pain that is worse with a cough or a deep breath.
• Patients with shortness of breath, a cough or rapid breathing that has built up over days or weeks.
• People with heart failure, liver disease, kidney disease or a past exposure to asbestos who notice new breathing trouble.
• Anyone told after a chest x-ray that fluid was seen near a lung.

What to expect

• Questions about when the breathing trouble began, what makes it worse, and your heart, lung, liver and kidney history
• A physical exam that includes listening to your lungs and tapping on the chest and upper back
• Blood work, which the practice offers, such as a blood count and kidney and liver tests
• A referral for a chest x-ray, ultrasound or CT scan, and to a lung specialist when those are needed

The two kinds of effusion

MedlinePlus describes two types. A transudative effusion happens when fluid leaks into the pleural space because of higher pressure in the blood vessels or a low blood protein count, and heart failure is the most common cause. An exudative effusion is caused by blocked blood or lymph vessels, inflammation, infection, lung injury or tumors. Knowing which type is present is why a provider may later test a sample of the fluid. For the heart side of the story, the heart failure management page explains how that condition is followed.

What it can feel like

The encyclopedia says the pain is usually sharp and worse with a cough or deep breaths, and that fever, chills, hiccups and rapid breathing can come with it. The shortness of breath guide explains the many causes of breathlessness, and a similar sharp pain on breathing without a large collection of fluid is covered in the pleurisy guide. Because some people have no symptoms, an effusion is sometimes discovered only when chest imaging is done for another reason.

Common causes and risk factors

MedlinePlus lists heart failure as the most common cause, along with infection, inflammation, lung injury, tumors, and liver or kidney disease. A lung infection that spreads to the lining is one route, and the pneumonia guide describes how pneumonia shows up. Advanced liver scarring is another, and the cirrhosis guide explains it. Risk factors named by the encyclopedia are smoking and drinking alcohol, because they can cause heart, lung and liver disease, and any history of contact with asbestos. The quitting smoking guide is a good place to start on the first of those.

How it is checked

Your provider will examine you, ask about your symptoms, listen to your lungs with a stethoscope and tap on your chest and upper back, according to MedlinePlus. An ultrasound of the chest, a chest CT scan or a chest x-ray may be enough to decide on treatment. A provider may also want to test the fluid by removing a sample with a needle between the ribs, looking for infection, cancer cells, protein levels, cell counts and sometimes acidity. Blood tests include a complete blood count and kidney and liver function tests. The practice offers the blood work; imaging and fluid sampling are done by referral.

Treatment and the cause behind it

The encyclopedia says the goals are to remove the fluid, prevent it from building up again and treat the cause. Removing the fluid, called thoracentesis, may be done when there is a lot of it and it is causing chest pressure, shortness of breath or a low oxygen level. If heart failure is the cause, water pills and other heart failure medicines may be used; if infection is the cause, antibiotics are given. In people with cancer or infection a chest tube is often used to drain the fluid. The outlook depends on the underlying disease, and the lung specialist, not the primary care office, performs these procedures.

When to be seen and when it is an emergency

MedlinePlus says to contact your provider or go to the emergency room if you have symptoms of a pleural effusion, and also for shortness of breath or trouble breathing right after thoracentesis. Call 911 for severe trouble breathing, blue or gray lips, or chest pain with fainting or a racing heart. Sudden breathlessness with sharp chest pain, especially after a long trip or surgery, can also mean a blood clot in the lung, which the pulmonary embolism warning signs guide describes. Complications of an effusion can include lung damage and infection of the fluid.

Sources

• MedlinePlus Medical Encyclopedia: Pleural effusion
• MedlinePlus: Pleural Disorders