Pleural Effusion

Pleural Effusion (Fluid in the chest)

Excessive fluid may accumulate because the body does not handle fluid properly (such as in heart failure, or kidney and liver disease). The fluid or water in pleural effusions also may result from inflammation, such as in Pneumonia, Tuberculosis and many other conditions. In our country, Pneumonia and Tuberculosis are two of the commonest causes of Pleural Effusion.

Symptoms of Pleural Effusion

The most common symptom of pleural effusion is shortness of breath or difficulty in breathing. As the effusion grows larger the more difficult it is for the person to breathe. Chest pain is also a symptom of pleural effusion and occurs because the pleural lining of the lung is irritated. The pain is usually described as a sharp pain, worsening with a deep breath. The commonest cause of Pleural Effusion in our country is tuberculosis however, it can occur due to tumors (cancers) and numerous other causes also.

Initially, Pleural effusions may not cause any symptoms. Later on, as the amount of fluid increases it can cause symptoms like:

• Shortness of breath
• Pain in the Chest
• Cough
• Fever

Diagnosis of Pleural Effusion

The diagnosis is made by the analysis of the fluid aspirated from the chest. If inconclusive it can be repeated two or three times.

Pleural Effusions can be diagnosed by following investigations:

• Chest X-ray film
• Ultrasound
• CT SCAN

Treatment of Pleural Effusion

However, if the aspiration is inconclusive and fails to provide an answer, key-hole visualization of inside of the chest (diagnostic thoracoscopy) is the procedure of choice and provide the answer in almost all of the cases.

The Treatment of pleural Effusion primarily depends on the cause: Aim of treating pleural effusion is to treat the cause effectively. Hence pleural effusion due to pneumonia is treated with antibiotics. Pleural Effusion due to tuberculosis is treated with Anti-tubercular Medicines. When the amount of pleural fluid is large and causing breathlessness, drainage of the fluid (Thoracentesis) is done to improve breathing. If it recurs again & again, a chest tube (or a pig tail catheter) may be inserted. Sometimes, the fluid becomes "Pus" and form a layer around the collapsed lung of forms multiple septations in the pus. This condition is now called "Empyema" (Pus around the Lungs) and need "Decortication" procedure. In this, we remove the thick layer (peel) from around the lung, thereby freeing it up to expand fully. Simultaneously, all the septations are broken, thorough wash is done to clear any infectious material and fresh chest tube is put under vision to drain any re-collection.

Traditionally, this procedure i.e. Decortication is done by Open method which involves cutting muscles & ribs resulting in weeks to months to recovery. We at Centre for Chest Surgery do the "SAME" procedure by Key-hole (VATS) Surgery where the whole procedure is carried out by 2-3 cm size holes, with no cutting of muscles or ribs. Patients have much "less pain" and blood loss and recover much faster, mostly back to work in few weeks, apart from cosmetically better outcome.

Sometimes the fluid accumulates due to involvement of pleura by cancer. In such cases, we drain the fluid by Chest tube to complete Lung expansion & put some chemicals (Pleurodesis) to fuse the pleural layers to prevent recurrence of pleural effusion.