Pleura is a thin membrane that covers the surface of the lungs and the inside of the chest wall, encompassing the pleural space. It is normal for this space to have some fluid (about 10 to 20 ml), as this allows the lungs to move smoothly within the chest cavity while breathing. However, if excess fluid builds up in the pleural space, a person may be diagnosed with pleural effusion.

Pleural effusion results from one of two mechanisms. The first is transudative and produced by fluid pushed through small vessels, mainly due to abnormal circulation within these vessels. The second is exudative and produced by the alteration of the neighboring tissue, or the membrane itself, and caused by inflammation or infiltration by tumor cells.

Transudative Pleural Effusion

This type of pleural effusion occurs when liquid leaks across a normal pleura. The condition creates only slightly more fluid than normal, so it rarely needs to be drained. Congestive heart failure is the most common cause of transudative pleural effusion. However, liver or kidney disease can also cause fluids to build up in the body and leak into the pleural space.



Exudative Pleural Effusion

This type of pleural effusion is often caused by pneumonia, tuberculosis, or some other lung infection. It is characterized by excess liquid leaking across damaged blood vessels into the pleura. Protein, blood, bacteria, or inflammatory cells can also seep into the pleural space. Depending on the amount of fluid present, and the severity of the impact on the breathing or other accompanying symptoms, the patient affected by the condition may need medical treatment.

Lung cancer can also cause this condition as well as other types of cancers that spread to the chest region. Autoimmune conditions such as rheumatoid arthritis or lupus can manifest as a pleural effusion.



Shortness of Breath

Depending on the amount of fluid collected in the pleural cavity, you might not have any symptoms whatsoever. However, if inflammation is present or the pleural effusion is moderate to large-sized, you may experience a few symptoms including shortness of breath.


Chest Pain

Chest pain is often associated with pleural effusion. Pleurisy occurs when the two layers of the pleura are inflamed, become swollen and rub against each other. Therefore, the pain is accentuated during deep breathing. If you notice chest pain, do not hesitate to consult with your physician.



Fever and Cough

Anytime you have a fever; your body is trying to fight off an infection or some other health ailment. Along with chest pain and shortness of breath, you might develop a cough. Although a fever and cough can be symptoms of a variety of illnesses, it might be a sign of pleural effusion. If your symptoms do not clear within a few days, visit your doctor for further diagnosis and treatment.




There are multiple ways for your physician to diagnose your condition from a physical examination to x-rays, CT scans, and ultrasounds. In most cases, your doctor will assess not only the liquid in the lungs but also the underlying condition that caused the leak. For example, antibiotics can treat pneumonia whereas diuretics can help with congestive heart failure.

If the pleural effusion is large enough, your doctor will need to remove it by a procedure called thoracentesis. Not only will this ease your symptoms, but it will allow your doctor to test the fluid for further diagnosis and treatment. Rarely, thoracentesis will be performed for direct administration of a specific medication.



Tube Thoracostomy

This treatment of pleural effusion involves the placement of a chest tube to drain usually thick pleural fluid. Your doctor will make an incision in the chest wall and insert a plastic tube into the pleural space under radiographic guidance. You will need close monitoring and may stay in the hospital for several days with the chest tube as it drains the fluid.


Pleural Drain

If you deal with recurring pleural effusions, long-term care might be required. A catheter can be placed in the pleural space for constant treatment. You will be able to drain the fluid from home. Discuss the risks and benefits with your doctor to determine if pleural drain is the right treatment for you.




During pleurodesis, talc or doxycycline is injected into the pleural space through a chest tube. Injecting the irritating substance will cause the chest wall and pleura to inflame. The inflammatory process will bind the outer and inner pleural membranes together tightly, which will obliterate the pleural space. In most cases, pleurodesis is used to prevent recurrent effusion.



Pleural Decortication

Pleural membranes that have become thick and inelastic because of long-standing inflammatory changes might restrict ventilation and result in labored breathing. Your surgeon may, therefore, recommend pleural decortication to free the trapped lungs. This surgical procedure consists in the removal of inflamed, unhealthy pleural membranes. Your medical provider can better discuss the pros and cons of this operation based on your specific condition.



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