The Things You Need to Know About Pleural Effusion

If you are hearing about pleural effusion for the first time, here are some of the important things you should know about pleural effusion. Pleural effusion, sometimes referred to as “water on the lungs,” is the build-up of excess fluid between the layers of the pleura outside the lungs. The pleura are thin membranes that line the lungs and the inside of the chest cavity and act to lubricate and facilitate breathing.

Also, in healthy lungs, these membranes keep a small amount of liquid between the lungs and chest to prevent friction as the lungs expand and contract during breathing.



The type of fluid that forms a pleural effusion may be categorized as either transudate pleural effusions or exudate pleural effusions. Transudate pleural effusions are formed when fluid leaks from blood vessels into the pleural space. Chemically, transudate pleural effusions contain less protein and LDH (lactate dehydrogenase) than exudate pleural effusions. Examples of transudate pleural effusions include:

On the other hand, exudate pleural effusions are caused by proteins, blood, and inflammation of the pleura itself and are often due to disease of the lung. Examples of exudate causes include:

  • Lung cancer
  • breast cancer
  • Lymphoma
  • Pneumonia
  • Tuberculosis
  • Post pericardotomy syndrome
  • Systemic lupus erythematosus
  • Uremia or kidney failure
  • Meigs syndrome
  • Pancreatic pseudocyst
  • Ascites
  • Intra-abdominal abscess
  • Asbestosis and mesothelioma

What are the most common causes of pleural effusions?

Some of the most common causes of pleural effusion are other diseases and disorders, including:

  • Liver or kidney disease: Diseases such as cirrhosis may cause fluid to build up in the body and leak into the chest.
  • Congestive heart failure: Failure of the heart to pump blood properly can cause a buildup of liquid in the chest.
  • Autoimmune disorders: Disorders such as lupus or rheumatoid arthritis may target the lungs and create problems with the pleura.
  • Infections: Respiratory infections such as tuberculosis and pneumonia could progress and cause water on the lung.
  • Pulmonary embolism: A blockage in the arteries of the lung caused by a blood clot can cause the pleura to create too much liquid.
  • Cancer: Typically lung cancer, though any cancer which has progressed to the lungs or pleura can be the cause.
  • Complications from certain medical procedures can also trigger a pleural effusion as well. Open-heart surgery is a common cause, but any surgery involving the chest may also increase the risk of a pleural effusion.

Symptoms of pleural effusion

Physical symptoms of a pleural effusion commonly show up as liquid fills the chest cavity. These symptoms include the following:

  • Shortness of breath
  • Rapid breathing
  • Chest pain, especially when breathing in deeply (This is called pleurisy or pleuritic pain.)
  • Fever
  • Dry cough or unproductive cough

Also, a person who often experiences hiccups or a pattern of hiccups that do not go away may also be experiencing pleural effusion.

What are the complications?

The potential complications associated with pleural effusion are:

  • Lung scarring,
  • Pneumothorax (collapse of the lung) as a complication of thoracentesis,
  • Empyema (a collection of pus within the pleural space), and
  • Sepsis (blood infection) sometimes leading to death.

How is it diagnosed?

The tests most commonly used to diagnose and evaluate pleural effusion include:

  • Chest X-ray: Pleural effusions appear white on X-rays, while air space looks black. If a pleural effusion is likely, you may get more X-ray films while you lie on your side. These can show if the fluid flows freely within the pleural space.
  • Computed tomography (CT Scan): CT scans of the chest, provide more accurate images for doctors to help determine the underlying cause.
  • Ultrasound: Ultrasound probe on your chest will create images of the inside of your body, which show up on a video screen. Also, it will be used at the bedside as a quick way of confirming the fluid and its location. It can help decide whether the fluid is free flowing within the pleural space or whether it is contained in a specific area (loculated).
  • Thoracocentesis: A needle and a tube called catheter is inserted between the ribs to remove a biopsy, or sample of fluid.
  • Pleural fluid analysis: An examination of the fluid removed from the pleura space

When the pleural effusion has remained undiagnosed despite previous, less-invasive tests, thoracoscopy may be performed. Thoracoscopy is a minimally invasive technique, also known as video-assisted thoracoscopic surgery, or VATS, performed under general anesthesia that allows for a visual evaluation of the pleura. Often, treatment of the effusion is combined with diagnosis in these cases.

Is it possible to prevent a pleural effusion?

The development of pleural effusions may sometimes be prevented by the early treatment of the underlying causes listed above. However, in certain cases, the development of pleural effusions may not be preventable. Some pleural effusions may be prevented from reoccurring by having individuals undergo pleurodesis, a procedure that seals up the pleural space.


Although pleural effusion causes painful and uncomfortable symptoms, there are several treatment options doctors use to manage the condition. Some aim to remove the fluid to alleviate symptoms (palliative), while others prevent future accumulations or treat the cause of the fluid buildup.

Procedures for treating pleural effusions include:

  • Thoracocentesis: If the effusion is large, your doctor may take more fluid than he/she needs for testing, just to ease your symptoms.
  • Tube thoracostomy (chest tube): Your doctor makes a small cut in your chest wall and puts a plastic tube into your pleural space for several days.
  • Pleural drain: If your pleural effusions keep coming back, your doctor may put a long-term catheter through your skin into the pleural space. You can then drain the pleural effusion at home. Your doctor will tell you how and when to do that.
  • Pleurodesis: Your doctor injects an irritating substance (such as talc or doxycycline) through a chest tube into the pleural space. The substance inflames the pleura and chest wall, which then bind tightly to each other as they heal. Pleurodesis can prevent pleural effusions from coming back in many cases.
  • Pleural decortication: Surgeons can operate inside the pleural space, removing potentially dangerous inflammation and unhealthy tissue. To do this, your surgeon may make small cuts (thoracoscopy) or a large one (thoracotomy).



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