What is pleural effusion?

Pleural effusion sometimes referred to as “water in the chest”.
What are the symptoms of pleural effusion?
• Chest pain
• Dry, nonproductive cough
• Dyspnea (shortness of breath, or difficult, labored breathing)
• Orthopnea (the inability to breathe easily unless the person is sitting up straight or standing erect)
What causes pleural effusion?
The most common causes of transudative (watery fluid) pleural effusions include:
• Heart failure
• Pulmonary embolism
• Cirrhosis
• Post open heart surgery
Exudative (protein-rich fluid) pleural effusions are most commonly caused by:
• Pneumonia
• Tuberculosis
• Cancer
• Pulmonary embolism
• Kidney disease
• Inflammatory disease
Other less common causes of pleural effusion include:
• Autoimmune disease
• Bleeding (due to chest trauma)
• Chylothorax (due to trauma)
• Rare chest and abdominal infections
• Asbestos pleural effusion (due to exposure to asbestos)
• Meig’s syndrome (due to a benign ovarian tumor)
• Ovarian hyperstimulation syndrome
How is pleural effusion diagnosed?
• Chest x-ray
• Computed tomography (CT) scan of the chest
• Ultrasound of the chest
• Thoracentesis (a needle is inserted between the ribs to remove fluid)
• Pleural fluid analysis (an examination of the fluid removed from the pleura space)
How is pleural effusion treated?
• Thoracocentesis – remove all fluid (water) with syringe and needle
• Thoracostomy – a small tube inserted between the ribs into the chest cavity to remove all water.
• Thoracoscopy – Video-assisted Thoracoscopy, like laparoscopy a small cut is made between ribs and telescope passed into the chest cavity. Where lung is separated from the chest wall, all pus (water) is removed under vision.
• Antibiotics if infection and chemotherapy/radiotherapy if cancer.

Dr Chintan Shankar Patel
MBBS, DNB (TB & CHEST Physician)