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Pleural Effusion (Fluid in the chest)

Pleura are the thin membranes that line the inner wall of the chest cavity and the surface of the lung. Normally, the pleura of the chest cavity come in contact with the pleura of the lung. Pleural effusion refers to fluid that has escaped from blood vessels or other small vessels called lymphatics.

Therefore, a pleural effusion is fluid that abnormally collects in the chest cavity between the inside chest wall and the lung. The fluid is not inside the lung. When fluid collects inside the lung air sacs, it is called pulmonary congestion or in severe cases pulmonary edema.

Sometimes, up to several liters of fluid can accumulate. When a large volume of fluid accumulates in either the right or left chest cavity, it can interfere with lung function because the lungs cannot fully expand, and this can cause shortness of breath.

Pleural fluid usually either is clear or has a slight yellowish straw color. In many cases, it is quite similar to the serum or plasma of the blood, without the red and white blood cells.

Causes of pleural effusions:

  1. Congestive heart failure: water is retained inside the body. As a result of this fluid overload, water start accumulating in the pleura causing pleural effusion.
  2. Liver failure
  3. Kidney failure
  4. Tumors of the pleura and lungs: for example mesothelioma and lung cancer. Fluid collection can be bloody with these tumors.
  5. Infections such as pneumonia: In this case, the body fights organisms with antibodies and attacking cells called macrophages. The result of this battle is a pleural fluid called pus.
  6. Trauma: such as fracture ribs or gun shot. The fluid collected in this case is blood and the condition is known medically as hemothorax.

Diagnosis:

Pleural effusions can be without symptoms in its early stages and when the collected fluid increases, you may experience shortness of breath. Sometime it is preceded with stitching pain in the chest. When the doctor listens to your chest, the air entering into your lugs is decreases. Chest x-ray and CT scan confirm the diagnosis.

Treatment:

The treatment of pleural effusion depends on its cause. If for example cancer is the cause, surgical removal and chemotherapy are used.

The simplest and most immediate way to treat a pleural effusion is to do a procedure called a pleurocentesis, or “chest tap,” in which a small area of skin on the chest is injected with a numbing drug so no pain is felt, and then a wide bore a needle is inserted through the chest wall into the pleural cavity, and the fluid is aspirated.It is recommendeed that a maximum of 2 liter to be removed in each tapping setting. Sometimes, if it recurs or if the pleural fluid is rather thick and won’t come through the needle, a small incision is made in the side of the chest after numbing the skin and a special chest plastic tube about the diameter of a finger is inserted into the chest cavity to drain this fluid.

Rarely, a major surgical procedure is necessary to remove this fluid and treat the underlying cause.

If this fluid is present because of heart failure, it can frequently be treated by medicine that addresses the heart failure. Diuretic drugs cause the patient to excrete excess fluid through the kidneys, and this will help the pleura to reabsorb this excess fluid in the chest cavity.

Small pleural effusions are frequently present after heart operations and usually are reabsorbed naturally during the first few weeks after the surgery. they are common in patients who underwent CABG  especially those patients in whom the left internal mammary artery  is used as a graft. Occasionally, pleurocentesis is necessary to draw off this fluid, and sometimes a second pleurocentesis may be necessary. Sometimes a chest tube has to be placed to remove this fluid. Usually, once it has been treated after heart surgery, pleural effusion does not recur.

 

 

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