Pleural effusion is a medical condition characterized by fluid accumulating in the pleural space located between the chest cavity and lungs. The outside of the lungs is covered in pleura, a type of thin membrane. A small amount of fluid is naturally present in this space to ensure adequate lung lubrication for expansion during breathing. However, when too much fluid develops, this can cause symptoms, such as a dry cough, fever, trouble breathing, and chest pain. There are two types: transudative and exudative. Transudative means fluid is leaking into the pleural space due to increased blood vessel pressure and low protein. Congestive heart failure and pulmonary embolism are possible causes of this. The exudative type might result from inflammation, kidney disease, cancer, or tumors.
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Draining Fluid/Pleural Drain
Draining fluid is a common treatment option for pleural effusion. This may involve inserting a small tube or using a needle to remove the fluid from the area. This is typically done through the chest. Before the tube insertion or needle draining, patients are generally given local anesthesia to numb the area to reduce some discomfort. However, it is possible to still experience some pain, especially after the medicine wears off. It is possible for the fluid to reaccumulate after a doctor drains it, and when this happens, this procedure might be performed again. Alternatively, doctors might choose to use another treatment method to remove excess fluid.
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Pleurodesis involves using medicine to essentially seal the pleural cavity so fluid does not have any space to accumulate. The medicines used for this procedure create a sticky surface on the outside of the lung so it adheres to the chest wall. Before the procedure, patients are typically given medications to relax them and control their pain. A tube is inserted into the chest so the doctor has direct access to the pleural space. The medicine that will seal the space is then injected into the tube. Since the medicine needs to coat the chest cavity, patients are usually asked to move every ten minutes, on average, during this procedure. Doctors usually use a small camera with this procedure to make sure everything is going into the right place.
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Tube thoracostomy can be used for all pleural effusions, but it is generally reserved for more complicated cases. The tubes are typically inserted using imaging technology to ensure proper placement. When possible, doctors use a small-bore tube to ensure greater comfort for patients. How long the tube stays in place depends on several factors. Before putting the tube into place, doctors typically administer a local anesthetic to promote comfort. A small incision is made in the area where the tube will be placed, and once the tube is in, it is stitched into place, and a bandage is placed over it. Once it is determined the excess fluid is sufficiently drained, the tube is removed, and the incision is closed.
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Treating The Cause
Treating the cause is imperative to prevent the risk of pleural effusion recurrence. If congestive heart failure is the cause, surgeries, medications, and dietary changes are often combined to manage the congestion. With a pulmonary embolism, emergency treatment is typically needed since this can be a life-threatening condition. Doctors might use surgery to remove the clot. Pneumonia is typically treated with antibiotics, fluids, and rest. The type of kidney disease will determine the treatment. In the most severe cases, hemodialysis might be needed. If there is a tumor, doctors may use radiation, surgery, or chemotherapy to either remove it or at least debulk it so it is smaller.
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Risks Associated With Treatment
There are risks associated with treatment for all of the methods used to resolve pleural effusion. With any procedure that involves draining the excess fluid, there is a risk for infection. This is due to a break being made into the skin where bacteria can enter. When needles and tubes are inserted, there is the risk for bleeding if a blood vessel is damaged.
Additionally, it is not uncommon for patients to experience pain during and after these procedures. For some patients, the pain can be quite intense, especially during the insertion procedure for a tube thoracostomy. With treatments that involve placing tubes, it is possible for the tube to either fall out or not be placed properly. While rare, these treatments might also carry the risk of a collapsed lung, bleeding into the pleural space or the diaphragm, lung, or stomach being injured. With pleurodesis, risks may include pus accumulating in the pleural space and blood clots.