Pleural Effusion

What is Pleural Effusion?

A pleural effusion occurs when fluid enters the pleural space and accumulates there. This is also called the pleural space because it is usually very narrow. It is formed by the pulmonary pleura (inner pleural leaflet) and the costal pleura (outer pleural leaflet). It contains, under normal circumstances, only a few milliliters of protein-rich fluid, which is constantly exchanged. The resulting vacuum nestles the two pleural layers together, ensures that the two layers slide smoothly, and prevents the lung from collapsing.

How Does Pleural Effusion Occur?

There are numerous reasons why the pleural space may be filled with fluid.

In most cases, diseases of the pleura are the cause of the effusion. For example, pneumonia, which spreads to the pleura, or tumors of the lung or the pleural layers, can cause fluids to be secreted into the pleural space.

In addition, certain autoimmune diseases cause altered osmotic pressure of the blood plasma, and as a result, increased fluid is released into the pleural space.

Similarly, accidents can cause bleeding into the pleural space, often seen after rib fractures or surgical procedures.

Is Pleural Effusion Dangerous?

Often, pleural effusion develops rather slowly and is milder. However, when severe, pleural effusion can be dangerous and a medical emergency. Because the pleural space is typically very narrow, it also takes up very little room. If a particularly large amount of fluid enters, this will demand space, displacing essential organs in the chest, such as the lungs and even the heart, in more severe cases.

Pleural Effusion Symptoms

Mild pleural effusions of up to 500 milliliters usually cause no symptoms in the patient and are often concomitants of other conditions, such as a viral infection.

However, if more fluid accumulates, shortness of breath during physical exertion or even at rest is the first symptom. Patients may tend to have accelerated breathing (tachypnea) and suffer from coughing. Pain is particularly noticeable when the pleura is involved, as the pleura is not sensitive to pain. Many patients also suffer from insomnia.

Diagnosis and Therapy

The suspicion of a pleural effusion usually arises in the physical examination, in which the physician palpates the chest, taps, listens, and closely observes breathing movements. A subsequent X-ray diagnosis is sufficient to confirm this suspicion. However, ultrasound examination is also very suitable for detecting pleural effusions. In addition, it has the advantage that the patient can remain in any position - in contrast to X-rays - a particularly important aspect in intensive care patients.

For smaller fluid collections, computed tomography is usually required. This provides precise information about the amount of effusion and the status of the surrounding tissues. Therefore, the treating physician already understands the possible cause of the diagnostic CT.

In most cases, a pleural puncture is necessary for clarification. In this procedure, a narrow instrument is inserted into the pleural space, and fluid is removed from its cavity. In the case of more extensive collections, this also has a therapeutic effect, as the pressure on the lungs is reduced, and the breathing capacity is directly increased. However, as little as 50 milliliters is sufficient for the diagnostic procedure. Then, the extracted fluid is sent to special laboratories where its composition is examined. Among others, the protein composition, microbes (bacteria, viruses, or others) in the effusion, endogenous cells, and certain enzymes are tested.

The laboratory results often provide sufficient information about the cause of the pleural effusion, and therapy can be started. However, if there is still uncertainty, the treating physician can still access the tissue sampling or endoscopic examinations.

The focus of therapy is always the underlying disease that has led to the pleural effusion. The effusion may heal spontaneously with smaller fluid collections and require no action. However, if it is larger and requires space, thus stressing the patient and causing symptoms, relief by drainage is indicated. Here, a similar principle is used that was mentioned above as a diagnostic. First, a catheter is forwarded between the ribs to the pleural space and connected to a vacuum-filled collection bag. This creates a suction that draws the fluid out of the pleural space.

Pleurodesis can help with recurrent pleural effusions. This deliberately triggers an inflammatory reaction on the surfaces of the pleura and lung, resulting in scarring of both lung lobes and a loss of the pleural space, so fluid can no longer accumulate.

Which Doctors and Clinics Specialize in Pleural Effusion?

Every patient who needs a doctor wants the best medical care. Therefore, the patient is wondering where to find the best clinic. As this question cannot be answered objectively, and a reliable doctor would never claim to be the best one, we can only rely on a doctor's experience.

We will help you find an expert for your condition. All listed doctors and clinics have been reviewed by us for their outstanding specialization in pleural effusion and are awaiting your inquiry or treatment request.