What is a pleural effusion?
Pleural effusion is a pathological accumulation of fluid in the pleural cavity, the pleural gap or pleural space – i.e. the area between the rib cage and the lungs. Pleura (Greek) means pleura, the thin skin that covers the lungs and lines the chest cavity. It is also known colloquially as the pleura of the lungs and ribs. The space between the two membranes or skins is called the pleural space. A thin film of fluid in the pleural cavity ensures the smooth, gliding movement of the lungs against the chest during breathing. It is absorbed by the tissue layers over the course of an hour and is constantly reformed.
If you are healthy, there is a balance between absorption and regeneration of the fluid. However, if too much fluid is produced or too little is absorbed as a result of a disease, the balance is disturbed, the fluid collects between the tissue layers and pleural effusion occurs. It is therefore not a disease in its own right, but the result of a disease that needs to be identified through careful, differentiated diagnostics. Depending on its composition, the liquid is divided into
- Transudate – pleural fluid with a low protein content, the relationship between new formation and absorption of the pleural fluid by the pleura is disturbed. However, the pleura itself is healthy. In most cases, the cause is kidney, liver or heart failure – and
- Exudate – pleural fluid with a high protein content, usually produced as a result of tumors or inflammation.
Pleural effusion: causes and risk factors
Pleural effusion can be caused by various diseases. The most common causes are heart failure, tumor diseases, pneumonia or pulmonary embolisms.
The composition of the pleural fluid gives us an initial indication of the direction in which we need to investigate further. Leakage of protein-containing liquid can be caused by the following:
- Pneumonia and/or pleurisy
- Tuberculosis
- Pulmonary embolism
- Cancer
- Pancreatitis, abscess under the diaphragm
- Rib fracture, injury to the rib cage
- Rheumatoid arthritis
If there is a leak of non-inflammatory fluid, the following causes must be looked for:
- Heart failure (cardiac insufficiency)
- Liver insufficiency
- Renal insufficiency or nephrotic syndrome with water retention in the tissue
In addition to the distinction between exudate and transudate, there are also special forms of pleural fluid:
- Empyema: Pus has accumulated in the pleural cavity. Hematothorax: Bleeding has occurred, the fluid contains blood, usually due to an injury (rib fracture) or tumor infestation.
- Chylothorax: Accumulated lymph fluid due to injuries or diseases of the lymph channels
The pleural fluid is therefore usually carefully examined in the laboratory for
- Bacteria and mycobacteria
- Tumor cells
- Protein content
- Hemoglobin concentration
Symptoms: Pleural effusion
Pleural effusion often lacks clear symptoms or complaints. Depending on the amount, however, it can cause breathing difficulties (shortness of breath). Occasionally there is also pain when breathing or coughing.
Pleural effusion – diagnosis with us
During the physical examination, the lungs are first listened to with a stethoscope and tapped with fingers. A soft breathing sound when listening and a muffled knocking sound are typical first signs of a pleural effusion. Sonography (ultrasound) can be used to visualize the extent of fluid accumulation between the lungs and the chest wall. X-rays or computer tomography can also be used for diagnosis.
Puncture and imaging procedures for pleural effusion
Once it has been established that it is a pleural effusion, the next step is to carry out a differential diagnosis. The effusion can be punctured relatively easily and painlessly with a thin hollow needle (pleural puncture). The analysis of the pleural fluid is crucial for the above-mentioned analyses. The position and structure of the effusion can be examined more closely using ultrasound images or X-rays. If the cause remains unclear despite the analysis of the effusion fluid, the chest cavity and pleura can also be examined visually using thoracoscopy.
If you have been diagnosed with a pleural effusion, it is also important for us to take a careful medical history:
- What pre-existing conditions are there?
- Have the symptoms persisted for a long time?
- What about heart health?
- What medication are you taking?
Because the symptom of pleural effusion can occur in a whole range of different diseases, comprehensive differential diagnosis is important. Physical examination, laboratory analysis of the punctate and imaging procedures help to identify the underlying disease. In older people in particular, several diseases may be the cause. The appropriate therapy is then tailored to the findings.
Pleural effusion - prevention and progression
A pleural effusion can hardly be prevented, as it occurs as a result of another disease. In any case, it makes sense to contact us if you experience any discomfort or even pain when breathing. These symptoms do not go away on their own, they may be signs of a complex disease process. In the case of pneumonia, antibiotics help to prevent pleural effusion. Quitting smoking reduces the risk of developing lung cancer, which in turn can trigger a pleural effusion. The course of a pleural effusion depends on how successfully the underlying disease can be treated.
Pleural effusion - treatment
After careful diagnosis, we will concentrate on treating your underlying disease.