What Is Pleural Effusion (Fluid in the Lungs)?

Pleural effusion is the medical term for excessive fluid buildup in the pleural cavity between the chest wall and the lungs. It is popularly known as ‘water on the lungs’. Pleural effusion can result in diminished breathing capacity and possible lung collapse. It has a wide variety of causes, including cancer, heart disease, pneumonia, kidney disease, and cirrhosis of the liver. Smokers, alcoholics, and persons with hypertension run a higher level of risk for this condition.

If you or a loved one is showing signs of pleural effusion or another form of lung trouble, the respiratory specialists at Baptist Health are available to help.

What Are the Symptoms of Pleural Effusion?

Pleural effusion is characterized by the following symptoms:

• Chest pain
• Fever
• Unproductive coughing
• Labored breathing
• An inability to breathe in any but a standing or sitting position (orthopnea).
• Regular hiccupping
• Fatigue from physical activity.

Left untreated, pleural effusion can have serious medical complications. These include a partially collapsed lung, infections, bleeding, and pulmonary edema (fluid in the lungs).

What Causes Pleural Effusion?

Pleural effusion is caused by a broad range of medical conditions that can be categorized according to the nature of the fluids introduced to the pleural cavity.

Transudative Pleural Effusions

Transudative pleural effusions are marked by watery, protein-poor fluid buildups. Causes include:

• Congestive heart failure
• End-stage kidney disease
• Liver cirrhosis
• Meigs syndrome
• Nephrotic syndrome
• Pulmonary embolism
• Severe hypothyroidism (myxedema).

Exudative Pleural Effusions

Protein-rich fluids characterize exudative pleural effusions. Common causes are:

• Cancer
• Infections
• Inflammatory disease
• Kidney disease
• Pancreatitis
• Pneumonia
• Pulmonary embolism
• Pulmonary infarction
• Trauma.

Other sources of pleural effusion include autoimmune diseases, tuberculosis, asbestos exposure, and ovarian hyperstimulation syndrome.

Pleural effusions can also be classified by fluid origin. Sources of fluid buildup include:

• Whole blood
• Pus
• Urine
• Serous fluid (the non-clotting components of blood)
• Chyle (a mixture of lymph and fats formed in the small intestines).

How Is Pleural Effusion Diagnosed?

To diagnose pleural effusion, your physician will document symptoms and conduct a physical exam. He or she will also arrange for:

• A chest X-ray: X-rays can provide evidence of pleural effusions, which appear white on an X-ray image.
• A CT scan: A CT scan is an X-ray series that provides a cross-sectional view of the lungs. This image will provide greater detail than that of a single X-ray. 
• A chest ultrasound: Ultrasounds are used to pinpoint invasive fluids in pleural space, which is useful in determining where biopsy samples should be drawn.
• Thoracentesis: This is a procedure for retrieving pleural fluid from the chest cavity. A catheter is inserted between the ribs to extract a sample for analysis. 
• Pleural fluid analysis: Pleural fluid is evaluated in a medical lab, to determine the nature, origin, and cause of fluid buildup in the chest cavity.

How Is Pleural Effusion Treated?

Pleural effusion treatment will depend on the cause, severity, and extent of the condition. Treatment methods include:

• Chest-tube drainage: A small plastic tube is inserted in the chest to remove fluid. The time required can run to several days.
• Chemotherapy: If the fluid in the pleural cavity is malignant, chemotherapy or other forms of cancer treatment may be utilized.
• Diuretics: Diuretics are medications that remove excess fluids from the body by means of urination. They are often used to remedy fluid buildup following congestive heart failure. 
• Pleural drain: If pleural effusion is recurrent, your physician may opt for inserting a long-term catheter into your pleural cavity. You will be taught how to operate the drain at home.
• Pleurodesis: Pleurodesis is a major invasive technique for persons with recurrent cases of pleural effusion and pneumothorax. It involves the purposeful irritation of the pleural cavity, joining it to the chest wall, and eliminating the possibility that fluid or air can enter the membranous structures surrounding the lungs.
• Surgery: Surgical procedures include open-chest thoracotomy and video-assisted thoracoscopic surgery (VATS). The former utilizes a catheter to suction out fluid from the pleural cavity; the latter is a minimally invasive procedure using tiny cameras and surgical tools to repair or remove unhealthy tissue from the pleural cavity.

Pleural effusion is a serious and potentially life-threatening medical condition. Early diagnosis and treatment increase the possibility of recovery. Individuals hospitalized for this condition often take several weeks to fully recuperate, following surgery or other forms of medical intervention.

Can Pleural Effusion be Prevented?

There is no certain means of preventing pleural effusion but it is possible to limit the impact of contributing factors. This would include smoking cessation, decreased alcohol consumption, and early diagnosis and treatment of pneumonia and cardiopulmonary illnesses.

Learn More About Pleural Effusion from Baptist Health

If you’re dealing with a respiratory ailment or condition, see your Baptist Health physician. He or she will be able to assess your condition and determine which medical treatments, if any, are most appropriate for you.