PLEURAL EFFUSION

DEFINATION-

”A pleural effusion is excess fluid that accumulates in the pleural cavity, the fluid-filled space that surrounds the lungs. This excess fluid can impair breathing by limiting the expansion of the lungs”.

Various kinds of pleural effusion, depending on the nature of the fluid and what caused its entry into the pleural space, are hydrothorax (serous fluid), hemothorax (blood), urinothorax (urine), chylothorax (chyle), or pyothorax (pus). A pleural effusion is excess fluid that accumulates in the pleural cavity, the fluid-filled space that surrounds the lungs. This excess fluid can impair breathing by limiting the expansion of the lungs. Various kinds of pleural effusion, depending on the nature of the fluid and what caused its entry into the pleural space, are hydrothorax (serous fluid), hemothorax (blood), urinothorax (urine), chylothorax (chyle), or pyothorax (pus).

  • PLEURAL EFFUSIN DEVELOPE-
    The pleura creates too much fluid when it’s irritated, inflamed, or infected. This fluid accumulates in the chest cavity outside the lung, causing what’s known as a pleural effusion.
  • Certain types of cancer can cause pleural effusions, lung cancer in men and breast cancer in women being the most common.

OTHER CAUSES OF PLEURAL EFFUSION INCLUDE-

  • Congestive heart failure (the most common cause overall)
  • Cirrhosis or poor liver function
  • Pulmonary embolism, which is caused by a blood clot and is a blockage in the lung arteries
  • Complications from open-heart surgery
  • Pneumonia
  • Severe kidney disease
  • Autoimmune diseases, such as lupus and rheumatoid arthritis

TYPES OF PLEURAL EFFUSION-
There are several types of pleural effusions, each with different causes and treatment options. The first classification of pleural effusions is either transudative or exudative.

1.TRANSUDATIVE PLEURAL EFFUSION-
This type is caused by fluid leaking into the pleural space as a result of either a low blood protein count or increased pressure in the blood vessels. Its most common cause is congestive heart failure.Transudates describes fluids that have migrated from other parts of the body usually due to unusual hydrostatic or oncotic pressures. They may even result from misguided catheters or nasogastric feeding tubes. Some medical conditions that can lead to transudates include;

  • Atelectasis
  • Cirrhosis
  • Congestive Heart Failure
  • Peritoneal dialysis

2.EXUDATIVE PLEULRAL EFFUSION-
Exudates describe fluids that have been produced by a process of inflammation. Not only will excess fluids be drawn to the area, tissue permeability will be altered and lymphatic drainage is impaired. Some conditions that can lead to exudates building up in the pleural space include;

  • Blocked lymph or blood vessels
  • Inflammation
  • Tumors
  • Lung injury
  • Common conditions that could result in this type of pleural infusion include pulmonary embolisms, pneumonia, and fungal infections.

3.COMPLICATED AND UNCOMPLICATED PLEURAL EFFUSION-
There are also complicated and uncomplicated pleural effusions. Uncomplicated pleural effusions contain fluid without signs of infection or inflammation. They’re much less likely to cause permanent lung problems.

Complicated pleural effusions, however, contain fluid with significant infection or inflammation. They require prompt treatment that frequently includes chest drainage.

SYMPTOMS AND SIGNS OF PLEURAL EFFUSION-

  • Sharp chest pain that is worse with deep breaths due to inflamed pleural surfaces rubbing together.
  • Laboured breathing due to the impairment of lung volume and mechanical lung movement.
  • Dry coughing from lung irritation.
  • Diminished chest expansion on the side of the effusion with deep breaths.
  • With a stethoscope breath sounds may sound louder due to resonance with the fluid, you may also hear the rubbing of the pleural layers.
  • The variety and severity of symptoms experienced will vary with the size of each pleural effusion.
  • Many smaller effusions will have no obvious outward signs and may only be detected whilst investigating other conditions. These may quickly resolve when the underlying condition is addressed.
  • Some people show no symptoms of pleural effusion. These people usually find out they have the condition through chest X-rays or physical examinations done for another reason.

COMMON SYMPTOMS OF PLEURAL EFFUSION-

  • Chest pain
  • Dry cough
  • Fever
  • Difficulty breathing when lying down
  • Shortness of breath
  • Difficulty taking deep breaths
  • Persistent hiccups
  • Difficulty with physical activity

DIAGNOSIS-

 X-RAY IN PLEURAL EFFUSION LEFT SIDE

Your doctor will perform a physical examination and listen to your lungs with a stethoscope. They may also order a chest X-ray to help diagnose pleural effusion. Other possible tests include:

  • CT scan
  • Chest ultrasound
  • Pleural fluid analysis
  • Pronchoscopy
  • Pleural biopsy

In a pleural fluid analysis, doctor will remove fluid from the pleural membrane area by inserting a needle into the chest cavity and suctioning the fluid into a syringe. The procedure is called a thoracentesis. This also works as a common procedure to drain the excess fluid from the chest cavity. The fluid will then be tested to determine the cause.

Doctor may also choose to perform a pleural biopsy, which involves taking a sample of tissue from the pleura. This can be done by inserting a small needle from outside the chest wall into the chest cavity.

If they discover a pleural effusion, but they’re unable to diagnose which type,  doctor may schedule a thoracoscopy. This is a surgical procedure that lets the doctor see inside the chest cavity using a fiber-optic camera.

For this procedure, doctor will make a few small incisions in the chest area while you’re under general anesthesia. Then they’ll insert the camera through one incision and the surgical tool through the other to extract a small amount of fluid or tissue for analysis.

TREATMENT OF PLEURAL EFFUSION-
The underlying cause of the condition and the severity of the effusion will determine treatment.

  • DRAINING FLUID-
    Generally, treatment involves draining the fluid from the chest cavity, either with a needle or a small tube inserted into the chest.
DRAINAGE FLUID

               DRAINAGE FLUID

  • PLEURODESIS-
    Pleurodesis is a treatment that creates mild inflammation between the lung and chest cavity pleura. After drawing the excess fluid out of the chest cavity, a doctor injects a drug into the area. The drug is often a talc mixture. This medication causes the two layers of the pleura to stick together, which prevents the future buildup of fluid between them.
  • SURGERY-
    In more serious cases, a doctor surgically inserts a shunt, or small tube, into the chest cavity. This helps redirect the fluid from the chest into the abdomen, where it can be more easily removed by the body. This may be an option for those who don’t respond to other treatments. PLEURECTOMY, in which part of the pleural lining is surgically removed, may also be an option in certain cases.

RISK OF PLEURAL EFFUSIONS-
Treatment for some cases of pleural effusion may be managed with medication and other supportive care. Most people recover within a few days or weeks. Minor complications from more invasive treatments can include slight pain and discomfort, which often go away with time. Some cases of pleural effusion can have more serious complications, depending on the severity of the condition, cause, and treatment used.

SERIOUS COMPLICATIONS CAN INCLUDES-

  • Pulmonary edema or fluid in the lungs, which can result from draining fluid too quickly during
  • thoracentesis
  • Partial collapsed lung
  • Infection or bleeding

PLEURAL EFFUSION AND CANCER-
Pleural effusions can be the result of cancer cells spreading to the pleura. They can also be the result of cancer cells blocking the flow of normal fluid within the pleura. Fluid may also build up as a result of certain cancer treatments, such as radiation therapy or chemotherapy.

Certain cancers are more likely to cause pleural effusions than others, including:

  • Lung cancer
  • Breast cancer
  • Ovarian cancer
  • Leukemia
  • Melanoma
  • Cervical cancer
  • Uterine cancer

The principle treatment approach with pleural effusion is to treat the underlying cause, which is usually more serious and will prevent further effusion. If the cause is not yet known and the fluid retention severe then a doctor can arrange to have it drained.

PHYSIOTHERAPY MANAGEMENT-
Treatment of your underlying condition and fluid drainage through a chest tube will be your primary sources of treatment for pleural effusion. Physiotherapy has an important role in stabilising and controlling your breathing, aiding in chest fluid drainage and clearing chest secretions. People whom receive respiratory physiotherapy as part of their treatment will tend to achieve a quicker recovery with fewer complications. Some of treatment techniques physiotherapy provides include;

  • Secretion clearance:
  • Effective / productive coughing techniques.
  • Postural drainage in sitting and lying.
  • Manual assistance, including percussion, vibrations and shaking.
  • Breathing technique retraining:

  • Controlling respiratory rate
  • Diaphragmatic breathing
  • Controlling / reducing breath volume
  • Relaxation breathing exercises

Education and Advice:

1- Treatment of the primary cause.
2- Build up the body resistance by proper diet.
3- Aspiration of the excess pleural fluid to reduce dyspnea.

• Positioning: on the normal side to improve ventilation/ perfusion ratio, also it
helps the movement on the affected side and subsequently helps the
drainage.
Breathing exercises: diaphragmatic and localized breathing exercises.
• Postural exercises: to maintain good posture and avoid chest wall unilateral
contracture.
• Aerobic exercises: as walking and up and down stairs to maintain physical
endurance and fitness.

 

 

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