A Pleural effusion is a build-up of fluid between the lungs and in the chest wall. It causes breathing difficulties because the lungs cannot expand normally when you breathe. Pleural effusion is a symptom of various diseases.
What is a pleural effusion?
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The pleural effusion is an accumulation of fluid in the pleural space. The lungs and the inner wall of the chest are lined with the pleura (pleura). This is a thin layer of skin that is needed for the lungs to expand as you breathe and slide along the wall of your chest.
There is usually a very small amount of fluid between the pleural leaves of the lungs and chest. However, various diseases cause this fluid to increase and accumulate in the pleural space.
The fluids are composed differently depending on the disease. A distinction is made between bloody pleural effusion (hemathotorax) and serous pleural effusion (serothorax), where "serous" means that the consistency of the liquid is similar to that of blood serum.
There is also the purulent pleural effusion (pyothorax) and the pleural effusion with lymph fluid (chylotorax). Thorax is the medical term for chest.
causes
Each type of pleural effusion is caused by different diseases. The most common trigger is heart failure, a chronic or acute heart failure that can lead to serothorax. Inflammation of the pleurisy (pleurisy) or malignant tumors can also cause the serothorax to develop.
In the case of a bloody pleural effusion, an injury is usually the cause; very rarely, it forms in the case of a tumor in the pleura. If the fluid is purulent, it is usually caused by bacterial pneumonia that is already well advanced. If the effusion consists of lymph fluid, there may be a lymph node disease that prevents the lymph from draining so that it collects in the pleural space.
This occurs, for example, in leukemia. Other diseases that can cause pleural effusion include breast cancer, ovarian cancer, lung cancer, and kidney cancer. This can lead to shortness of breath, abnormal breathing noises, breathing difficulties and anxiety. But fever and chest pain are also not uncommon.
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➔ Medication for shortness of breath and lung problemsDiseases with this symptom
- Heart failure
- pleurisy
- Liver failure
- tuberculosis
- Hodgkin's disease
- lung infection
- leukemia
- Kidney cancer
- Pleural mesothelioma
- Pulmonary embolism
- Breast cancer
- Ovarian cancer
- Lung cancer
- Pancreatitis
- Chylothorax
Diagnosis & course
The main symptom of a pleural effusion is difficulty breathing. However, they do not appear until a large amount of fluid has already accumulated. Smaller effusions are often not even noticed by those affected.
The pleural effusion forms slowly and only gradually the patient will experience shortness of breath and possibly pain, especially during exertion. In addition, there are also the symptoms of the illness that caused it. The doctor can recognize a suspected pleural effusion by listening to the breath sounds and tapping the chest.
An ultrasound examination (sonography), which makes the liquid clearly recognizable, provides security for the diagnosis. X-rays and computed tomography can also be used to confirm the diagnosis.
In order to be able to infer the underlying disease from the pleural effusion, the doctor must take a sample of the fluid. This is done through a pleural puncture, during which some of the fluid is removed from the pleural space with a cannula and then examined.
Complications
Pleural calluses in particular can be seen as a complication of pleural effusion. These can occur both if the pleural effusion has been treated by a doctor or if no treatment is given. The so-called pleural calluses are cicatricial adhesions of the pleural leaves. Most of the time, the pleural calluses are also thickened.
If the pleural effusion occurs as a result of pnuemony (pneumonia), it can also become infected. This is also a possible complication of the pleural effusion. An infected pleural effusion is technically referred to as a "complicated pleural effusion". There is also the risk that the infected pleural effusion will suppurate.
If such a purulent infection is present, it is referred to as pleural empyema. If the patient is given medical treatment in good time, the risk of complications is lower. Difficulty breathing, which is a symptom of the pleural effusion, can also lead to further complications or complaints. An example of this is fear that occurs in the patient and which often occurs as a result of severe shortness of breath.
In addition, care should be taken to ensure that the patient breathes deeply despite the pain caused by the pleural effusion. If this does not happen, the lungs may subsequently become infected, if one is not already present.
When should you go to the doctor?
In the event of a pleural effusion, a doctor should always be consulted. This disease can lead to serious complications without treatment and should therefore always be examined and treated by a doctor. As a rule, a doctor should be consulted if the pleural effusion causes difficulty breathing or shortness of breath. You should also seek medical advice if your body is less resilient or if you are constantly tired. The difficulty breathing can lead to loss of consciousness. If these complaints are very severe or if the person concerned loses consciousness, an emergency doctor can also be called.
Medical treatment must also be given if the pleural effusion causes pneumonia. This is a very serious condition for the body and, if left untreated, can lead to death. This inflammation manifests itself in pain when breathing. The person affected can also consult a doctor if they have panic attacks or sweats due to breathing difficulties. Here the patient can also turn to a psychologist. With an early diagnosis and therapy, most complaints can be limited.
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Treatment & Therapy
The treatment of a pleural effusion depends on its causes. If a large amount of fluid has already collected so that breathing is impeded, the doctor will puncture the pleural space once or several times to reduce the effusion.
This measure already provides relief from the acute symptoms. Should new fluid form again and again and very quickly, there is the possibility of inserting a chest drain. For this purpose, a so-called drainage tube is placed permanently in the pleural space, usually through a small skin incision, and guided outwards so that newly formed fluid can drain off again.
In addition, the underlying disease must be treated in any case. In the course of this treatment, the pleural effusion can be favorably influenced by physical measures. Breast wraps, breathing exercises or heat radiation are helpful, for example. One surgical option is thoracoscopy. It is used when bacterial infections have triggered the pleural effusion and have caused severe adhesions and suppuration on the pleura.
The adhesions are removed in an endoscopic procedure so that the lungs can quickly recover. If the underlying disease cannot be treated, there is still the option of pleurodesis. Here, the pleura of the lungs and pleura are glued together with the help of medication, so that no more fluid can collect there.
Outlook & forecast
As a rule, pleural effusion causes breathing difficulties. These can have a negative impact on health and lead to panic attacks in many patients. In most cases, abnormal and loud breathing noises also occur, so that the disease can be diagnosed relatively easily.
The symptom often leads to pneumonia, which if left untreated can be life-threatening for the patient. Most people affected suffer from acute shortness of breath. This does not have to occur permanently, but can be very annoying and uncomfortable, especially in stressful situations or when sleeping. It is also usually not possible for the patient to perform physical activities, which greatly reduces the quality of life.
In the case of a pleural effusion, the first treatment is aimed at alleviating the symptoms and does not lead to any further symptoms. After that, however, the underlying disease must be treated. As a rule, this requires an endoscopic procedure and the use of medication. Life expectancy is not limited as long as treatment of the pleural effusion is carried out early.
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➔ Medication for shortness of breath and lung problemsprevention
You cannot specifically prevent pleural effusion because it is triggered by diseases. However, if you experience breathing difficulties in the presence of certain diseases, it is advisable to clarify the causes as soon as possible so that any pleural effusion can be treated in good time.
You can do that yourself
In order to ensure the success of the treatment and to prevent any consequences (such as a fibrothorax or pneumonia), it is advisable to carry out breathing therapy exercises several times a day on your own.
First a physiological breathing rhythm should be trained. To do this, the patient places both hands on his stomach. Now inhale deeply through the nose. The attempt is made to direct the air under your own hands into the stomach. Then the exhalation through the mouth takes about twice as long as the inhalation. There is now a short pause for breath, which automatically makes the next breath deeper. This is repeated about five to six times. To prevent dizziness from the high oxygen intake, a short break is then made with shallow, normal breaths. If this works well, the position of the hands, and thus the direction of breathing, can be varied (for example in the flanks or under the breastbone to improve the mobility of the chest). This exercise improves the elasticity and ventilation of the lungs.
In order to additionally increase the oxygen supply, the pause between inhalation and exhalation can be shifted. With the so-called 4-7-8 method, for example, the patient counts to four while inhaling, then holds the breath while counting to seven (this gives the organism more time for gas exchange in the alveoli) , and exhales as he counts to eight. Again, this is repeated five to six times.
There is also a wide selection of breathing trainers (for example the Triflo) that can have a positive effect on recovery.
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