Pulmonary
- Critical Care Associates
of East Texas
Jeffrey M.
Shea, M.D., F.C.C.P.
Venkatesh Donty, M.D.
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Jeffrey M.
Shea, M.D., F.C.C.P. |
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Definition Pleura are the membranes that surround both lungs. They are moistened with a thin fluid, which reduces friction during respiratory movements of the lungs. A Pleural Effusion is a collection of fluid into a part of the pleural cavity, which is the space between the lung and chest wall.. Abnormal conditions that can fill the pleural space are air (pneumothorax), blood (hemothorax), plasma, serum or lymph (hydrothorax), or pus (pyothorax, empyema). Anything in the pleural space can compress the underlying lung and causes atelectasis (compression of the lung). Any fluid (with or without air) in the pleural space is subject to infection by direct contamination or through the blood stream.
Fluid may be detected by tapping on the back during a physical examination to determine the fluid level and usually can be seen on an x-ray of the chest.
There are 2 main types of pleural effusions: Transudates (low protein) and Exudates (all others).
Treating the underlying cause of the effusion is the hallmark of therapy. Infections are treated with appropriate antibiotics and occationally with drainage of the fluid with a tube inserted between the ribs and into the chest. If complete drainage cannot be achieved with chest tubes, then an operation to remove the infected pus and the lining of the lung or a portion of the surface lung tissue generally needs to be performed. If the pleural effusion is due to leakage of fluid into the pleural space, treatment may be diuretics such as lasix. If it is cancer, or where the fluid continues to accumulate, a procedure where the space is scarred down is often-times performed (called a pleurodesis). A Thoracentesis may be used to drain fluid repeatedly that may be causing symptoms of shortness of breath.
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Pleural effusions may also be associated with the leakage of fluid due
to higher than normal pressures in the lung circulation, such as with congestive heart
failure (CHF) or from low protein in the blood, as in liver disease, severe malnutrition,
and in certain kidney conditions when protein is filtered into the urine. Infection,
blockage of blood supply to the lung (Pulmonary Embolism), or cancer in the lung itself
can result in accumulation of fluid in the pleural space. If pleural effusions become
infected with bacteria, inflammatory reaction results that creates an abscess in the
pleural space (empyema). 
Initially, the fluid is removed during a thoracentesis where an area
below the fluid level is anesthetized and a needle is placed between the ribs and into the
space between the chest wall and the lung. The fluid is removed and sent to the laboratory
for analysis.