Pleural Effusion: Causes, Symptoms, Diagnosis, and Treatment

Introduction

Pleural effusion is a medical condition in which an abnormal amount of fluid accumulates in the pleural space, the area between the lungs and the chest wall. This condition can result from various underlying diseases and needs careful evaluation and management.

Causes

Pleural effusion can be classified into two main types based on the cause:

• Transudative Pleural Effusion:

  • Caused by conditions that alter the balance of pressure in blood vessels.
  • Common causes: Heart failure, liver cirrhosis, nephrotic syndrome.

• Exudative Pleural Effusion:

  • Results from inflammation, infection, or malignancy that affects the pleura.
  • Common causes: Pneumonia, tuberculosis, cancer, pulmonary embolism, autoimmune diseases (like rheumatoid arthritis and lupus).

Symptoms

Symptoms depend on the amount of fluid accumulated and the underlying cause. Common symptoms include:

• Shortness of breath (dyspnea)
• Chest pain (often sharp and worsens with breathing)
• Cough
• Fever (if due to infection)
• Fatigue

Diagnosis

Diagnosing pleural effusion involves:

1. Physical examination – Decreased breath sounds and dullness on percussion.
2. Imaging tests:
   • Chest X-ray – Shows fluid accumulation.
   • Ultrasound – Assesses fluid amount and guides procedures.
   • CT scan – Helps identify the underlying disease.
3. Thoracentesis – A procedure where a sample of pleural fluid is taken for laboratory analysis (protein levels, glucose, cell count, and infection markers).

Treatment

Management depends on the underlying cause:

• For transudative effusions (e.g., heart failure): Diuretics and treatment of the underlying disease.
• For exudative effusions:
  • Infection-related: Antibiotics and pleural drainage.
  • Cancer-related: Chemotherapy, radiotherapy, or pleurodesis (procedure to prevent fluid recurrence).
  • Recurrent large effusions: Thoracentesis or pleural catheter placement to relieve symptoms.

Conclusion

Pleural effusion is a serious condition requiring precise diagnosis and targeted treatment. Prompt medical evaluation is essential to manage underlying causes and prevent complications.

Source recommendations

1. American Thoracic Society Guidelines

1. https://site.thoracic.org/clinicians-researchers/clinical-practice-guidelines-statements-reports
2. https://www.thoracic.org/professionals/clinical-resources/critical-care/statements-and-guidelines/
3. https://site.thoracic.org/about-us/news/official-ats-documents
4. https://www.thoracic.org/statements/guideline-implementation-tools/
5. https://site.thoracic.org/

2. European Respiratory Society Guidelines

1. https://www.ersnet.org/science-and-research/development-programme/ers-clinical-practice-guidelines-statements-and-technical-standards/
2. https://publications.ersnet.org/content/erj/50/3/1700629
3. https://channel.ersnet.org/channel-25-guidelines
4. https://www.ersnet.org/
5. https://publications.ersnet.org/content/erj/early/2022/02/03/1399300301585-2021