Kanak Manjari Institute of pharmaceutical Sciences.
Pleural effusion is excess fluid that accumulates between the two pleural layers, the fluid-filled space that surrounds the lungs. Excessive amounts of such fluid can impair breathing by limiting the expansion of the lungs during ventilation.
REFERENCE ID: PHARMATUTOR-ART-2104
INTRODUCTION: A pleural effusion is a buildup of fluid in the pleural space, an area between the layers of tissue that line the lungs and the chest cavity. It may also be referred to as effusion or pulmonary effusion. The type of fluid that forms a pleural effusion may be categorized as either transudate or exudate. Transudate is usually composed of ultra filtrates of plasma due to an imbalance in vascular hydrostatic and oncotic forces in the chest (heart failure, cirrhosis), while exudate is typically produced by inflammatory conditions (lung infection, malignancy). Exudative pleural effusions are usually more serious and difficult to treat.
The pleura is a thin membrane that lines the surface of the lungs and the inside of the chest wall outside the lungs. In pleural effusions, fluid accumulates in the space between the layers of pleura. Normally, only teaspoons of watery fluid are present in the pleural space, allowing the lungs to move smoothly within the chest cavity during breathing. Numerous medical conditions can cause pleural effusions. Some of the more common causes are:
- Congestive heart failure
- Liver disease (cirrhosis)
- End-stage renal disease
- Nephrotic syndrome
- Pulmonary embolism
- Lupus and other autoimmune conditions
Excessive fluid may accumulate because the body does not handle fluid properly (such as in congestive heart failure, or kidney and liver disease). The fluid in pleural effusions also may result from inflammation, such as in pneumonia, autoimmune disease, and many other conditions.
Common symptoms associated with pleural effusion may include the following:
- chest pain,
- difficulty breathing,
- Painful breathing (pleurisy), and
- Cough(either a dry cough or a productive cough).
Deep breathing typically increases the pain. Symptoms of fever, chills, and loss of appetite often accompany pleural effusions caused by infectious agents.
TYPES OF PLEURAL EFFUSION:
Doctors also use the terms transudative and exudative to describe:There are two main categories of pleural effusions:
Uncomplicated pleural effusion: The pleural effusion contains fluid that is free of serious inflammation or infection. If large enough, an uncomplicated pleural effusion can cause symptoms. However, these pleural effusions rarely cause permanent lung problems.
Complicated pleural effusion: A complicated pleural effusion contains fluid that has significant inflammation or infection. If untreated, complicated pleural effusions may harden to form a constricting ring around the lung. This hardening process, called organization, can permanently impair breathing. To prevent organization, complicated pleural effusions require drainage, usually with a tube placed into the chest.
Transudative: The pleural effusion fluid is similar in character to the fluid normally present in the pleural space. Transudative pleural effusions rarely require drainage, unless they are very large. Congestive heart failure is an example of a condition that can cause a transudative pleural effusion.
Exudative: The pleural effusion fluid has excess protein, blood, or evidence of inflammation or infection. An exudative pleural effusion may require drainage, depending on its size and the severity of inflammation. Causes of exudative pleural effusion include pneumonia and lung cancer.
The type of pleural effusion can only be identified by taking a sample of fluid from the pleural effusion.
Treatment for pleural effusions may often simply mean treating the medical condition causing the pleural effusion. Examples include giving antibiotics for pneumonia, or diuretics for congestive heart failure. Large, infected, or inflamed pleural effusions often require drainage to improve symptoms and prevent complications. Various procedures may be used to treat pleural effusions, including:
Thoracentesis (described above) can remove large amounts of fluid, effectively treating many pleural effusions.
Tube thoracotomy (chest tube): A small incision is made in the chest wall, and a plastic tube is inserted into the pleural space. Chest tubes are attached to suction and are often kept in place for several days.
Pleurodesis: An irritating substance (such as talc or doxycycline) is injected 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 recurring, in many cases.
Pleural drain: For pleural effusions that repeatedly recur, a long-term catheter can be inserted through the skin into the pleural space. A person with a pleural catheter can drain the pleural effusion periodically at home.
Pleural decortication: Surgeons can operate inside the pleural space, removing potentially dangerous inflammation and unhealthy tissue. Decortication may be performed using small incisions (thoracoscopy) or a large one (thoracotomy).
• Broaddus C, Light RW. Pleural effusion. In: Mason RJ, Broaddus CV, Martin TR, et al, eds. Textbook of Respiratory Medicine. 5th ed. Philadelphia, Pa: Saunders Elsevier; 2010: chap 73.
• Celli BR. Diseases of the diaphragm, chest wall, pleura, and mediastinum. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 99
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