Pleural effusion is a buildup of fluid in the pleural cavity, which is the space between the pleural layer that covers the lungs with the pleural layer attached to the inner wall of the chest cavity. This condition is generally a complication of other diseases.
Under normal conditions, there is about 10 ml of fluid in the pleural cavity which acts as a lubricant to help smooth the movement of the lungs when breathing. However, in a pleural effusion, the amount of fluid is excessive and accumulates. This can cause breathing problems.
Causes of Pleural Effusion
Based on the cause, pleural effusion is divided into 2 types, namely:
Transudative pleural effusion
This pleural effusion occurs due to increased pressure in the blood vessels or low levels of protein in the blood, so that fluid seeps into the pleura. A number of diseases that are often the cause of this condition are:
- Congestive heart failure
- Liver cirrhosis
- Malignancy or cancer
- Pulmonary embolism
- Hypoalbuminemia
- Kidney disorders, such as nephrotic syndrome
Exudative pleural effusion
Pleural effusion occurs as a result of inflammation, lung injury, tumors, flow disturbances in lymph vessels. A number of diseases that are often the cause of this condition are:
- Cancer, generally lung cancer and breast cancer
- Pulmonary embolism
- Lung infections, such as tuberculosis and pneumonia
- Injury to the chest wall, which causes bleeding or chylothorax
- Autoimmune diseases, such as lupus or rheumatoid arthritis
In addition to some of the diseases above, pleural effusion can also occur due to several other conditions, such as taking certain drugs, including chemotherapy drugs, surgery on the abdomen or chest, and undergoing radiation therapy.
There are several factors that can increase a person's risk of having a pleural effusion, namely:
- Have hypertension (high blood pressure)
- Have a smoking habit
- Frequent consumption of alcoholic beverages
- Frequent exposure to asbestos dust
Symptoms of Pleural Effusion
A number of symptoms that can occur due to pleural effusion are:
- Hard to breathe
- Chest pain, especially when you inhale and exhale deeply (known as pleuritic pain)
- dry cough
The above symptoms are usually felt when the accumulation of fluid that occurs in the pleural effusion is severe. In mild pleural effusion, the patient may not feel any symptoms.
Several other symptoms will usually arise according to the underlying cause of the pleural effusion, such as fever, chills, loss of appetite, persistent hiccups, or swelling of the legs.
When to go to the doctor
See a doctor immediately if you experience the symptoms of a pleural effusion described above. This is important so that you can get the right treatment and so that complications can be prevented.
Make regular checks with your doctor if you have been diagnosed with pleural effusion or have a disease that has the potential to cause this condition. This needs to be done to monitor your health condition.
Pleural Effusion Diagnosis
To diagnose pleural effusion, the doctor will ask the patient's complaints and symptoms, as well as the patient's medical history. After that, the doctor will perform a physical examination of the chest which includes inspection (observation), palpation (touch), percussion (knock), and auscultation using a stethoscope.
In this examination, the doctor will look for several signs of pleural effusion, namely:
- The movement of the chest wall that seems unbalanced between the left and right sides, and the patient looks short of breath
- Vibration (tactile fremitus) that feels weaker in the fluid-filled chest
- Heavier or lower knocking (percussion) sound due to accumulation of fluid in the chest wall
- Weakened breath sounds in fluid-filled areas
To confirm the diagnosis of pleural effusion, the doctor will perform the following investigations:
- Scanning with X-rays or chest CT scans, to see if there is a buildup of fluid in the lungs
- Thoracentesis or throcacocentesis, which is a procedure for taking fluid from the chest cavity with a needle to reduce fluid that has accumulated as well as to take fluid samples to be analyzed in the laboratory
- Blood tests, to look for signs of infection and check kidney and liver function
- Lung biopsy, to detect the presence of abnormal cells or tissue in the lung
- Echocardiography, to check the condition of the heart and detect heart problems
- Bronchoscopy, to check for obstructions in the respiratory tract
Pleural Effusion Treatment
Treatment of pleural effusion aims to remove fluid from the pleural cavity, prevent recurrence of fluid accumulation, and treat the disease that underlies the occurrence of pleural effusion. Treatment methods that can be done are:
1. Thoracentesis
Thoracentesis is a medical procedure to remove excess fluid from the pleura through a needle that is inserted into the chest cavity. This procedure is generally performed when there is a large build-up of fluid in the lungs and causes the patient to have difficulty breathing and chest pain.
2. chest tube
chest tube is a procedure where a special tube (catheter) is placed in the pleural cavity through a small incision in the chest. This tube is connected to a machine to drain fluid from the pleura. The duration of discharge can last for several days so the patient needs to be hospitalized.
3. Pleural drain
This procedure is similar to chest tube, but the catheter is inserted in the long term. The patient can independently remove fluid from the pleura. This procedure is generally chosen when a pleural effusion persists.
4. Pleurodesis
Pleurodesis is the injection of a substance that triggers inflammation, such as: talc or doxycycline, into the pleural space. This procedure is generally performed after the fluid in the pleural space has been removed and is usually chosen when the pleural effusion recurs frequently.
5. Surgery or surgery
Surgery is selected when other techniques for removing fluid from the lung cavity are ineffective. The operation is performed by removing the tissue in the chest cavity that is suspected of causing a pleural effusion. There are two types of surgery that can be performed, namely thoracoscopy or thoracotomy.
6. Treat the cause of pleural effusion
Pleural effusion is generally caused by other diseases. Therefore, treatment of the underlying cause is done to treat the pleural effusion. Some examples of the handling that will be carried out are:
- Administration of diuretics and drugs for heart disease, if pleural effusion is caused by heart failure
- Administration of antibiotics, if the pleural effusion is caused by an infectious disease
- Chemotherapy and radiation therapy, if the pleural effusion is caused by cancer
Pleural Effusion Complications
If not treated immediately, pleural effusion can cause the following complications:
- Atelectasis, which is damage to the lungs due to the alveoli not being filled with air
- Empyema, which is a collection of pus in the pleural cavity
- Pneumothorax, the accumulation of air in the pleural cavity
- Thickening of the pleura and the appearance of scar tissue in the lining of the lungs
Pleural Effusion Prevention
There is no specific prevention for pleural effusion. However, there are several things that can be done to reduce the risk of lung disorders and maintain lung health, namely:
- Limiting alcohol consumption
- Stop smoking habit
- Use PPE (personal protective equipment) according to standards, when you work with potentially hazardous materials or substances, such as asbestos
- Regular check-ups with your doctor, if you have certain diseases or conditions, such as heart disease and autoimmune diseases