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Pleural Effusion Causes and Diagnosis

Pleural Effusion Causes and Diagnosis

December 14, 2021
Emily Cassidy, MD
Emily Cassidy, MD

Cardiothoracic Surgery

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Sometimes lung cancer can be associated with a pleural effusion. A pleural effusion is a buildup of fluid that occurs outside of the lung, but inside of the chest. It can become a really problematic situation, if you think of the chest as a rigid box and the lung as a sponge, if fluid builds up between that rigid box and that sponge, the sponge is what’s going to get compressed, which is the lung. So pleural effusions can cause significant shortness of breath. You can have a reactive pleural effusion, which is just related to inflammation because there’s something going on in the lung or in the chest wall that’s causing it to react. Or you can have what’s termed a malignant pleural effusion, which is where the fluid actually has cancer cells in it itself. A malignant pleural effusion can be difficult to diagnose.

 

Even when that fluid is drained, it can be hard to find those cancer cells within a large volume of fluid. So oftentimes there’ll be suspicion for malignant effusion and it will be a diagnosis that’s difficult to confirm. If a pleural effusion is felt to be malignant and continues to keep coming back despite drainage procedures, there may be a recommendation for an operation called a pleurodesis or a pleural catheter insertion. A pleurodesis is when the fluid is all drained off of the lung in the operating room typically. And then determination is made whether that lung is trapped or whether it’s able to re-expand. If the lung is trapped, a pleurodesis is not going to work, but if the lung is able to re-expand once the fluid is removed, a pleurodesis is where we put talcum powder throughout the chest cavity. There are other pleurodesing agents, but I would say that that’s the most common, with the goal of creating inflammation so that the lung will then stick to the chest wall. And that obliterates the space where the fluid is forming so that it doesn’t return. If, on the other hand, the lung is trapped, meaning that even with pushing air in, it’s not coming up enough to reach that chest wall, a pleurodesis is not going to be effective. In that scenario, the surgeon will typically place an indwelling pleural catheter, which is a soft, small silicone tube that sits under a bandage and the patient can go home with it and drain it as needed.