Pleural Effusion - malignant pleural effusion pathophysiology, cause, treatment

A pleural effusion is an accumulation of fluid between the layers of the membrane that lines the lungs and chest cavity. It can be detected on X-ray when 300 mL or more of fluid is present and clinically when 500 mL or more is present. The chest X-ray appearances range from the obliteration of the costophrenic angle to dense homogeneous shadows occupying part or all of the hemithorax. Fluid below the lung (a subpulmonary effusion) can simulate a raised hemidiaphragm. Fluid in the fissures may resemble an intrapulmonary mass.

Causes and risk factors associated with Pleural Effusion

Pleural fluid is formed in the body in small amounts to lubricate the surfaces of the pleura, the thin membrane that lines the chest cavity and surrounds the lungs. A pleural effusion is an abnormal collection of this fluid.

Two different types of effusions can develop: transudative and exudative. Transudative pleural effusions are usually caused by a disorder in the normal pressure in the lung. Congestive heart failure is the most common cause of transudative effusion. Exudative effusions form as a result of inflammation (irritation and swelling) of the pleura, which is often caused by lung disease. Cancer, pneumonia, tuberculosis and other lung infections, drug reactions, collagen-vascular diseases, asbestosis, and sarcoidosis are some diseases that can cause exudative pleural effusions.

The cause and type of pleural effusion is usually determined by thoracentesis (removal of a sample of fluid with a needle inserted between the ribs into the chest cavity).

Symptoms of Pleural Effusion

• Shortness of breath
• Chest pain, usually a sharp pain that is worse with cough or deep breaths
• Cough
• Hiccups
• Rapid breathing

There may be no symptoms.

Signs and various tests of Pleural Effusion

During a physical examination, the doctor will listen to the sound of your breathing with a stethoscope and may tap on your chest to listen for dullness.

The following tests may help to confirm a diagnosis of Pleural Effusion:

• Chest x-ray
• Thoracic CT
• Ultrasound of the chest
• Thoracentesis
• Pleural fluid analysis

Treatment of Pleural Effusion

Treatment may be directed at removing the fluid, preventing its re-accumulation, or addressing the underlying cause of the fluid buildup.

Therapeutic thoracentesis may be done if the fluid collection is large and causing pressure or shortness of breath. Treatment of the underlying cause of the effusion then becomes the goal.

For example, pleural effusions caused by congestive heart failure are treated with diuretics and other medications that treat heart failure. Pleural effusions caused by infection are treated with antibiotics specific to the causative organism. In patients with cancer or infections, the effusion is often treated by using a chest tube to drain the fluid. Chemotherapy, radiation therapy, or instilling medication within the chest that prevents re-accumulation of fluid after drainage may be used in some cases.

Complications during Pleural Effusion

• A lung surrounded by a fluid collection for a long time may collapse.
• Pleural fluid that becomes infected may turn into an abcess, called an empyema, which requires prolonged drainage with a chest tube placed into the fluid collection.
• Pneumothorax (air within the chest cavity) can be a complication of the thoracentesis procedure.

Malignant Pleural Effusions

Malignant Pericardial Effusions

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