Pleural Effusion

A Pleural Effusion is the accumulation of fluid in the pleural space, which is the area between the layers of tissue that line the lungs and the chest cavity. There are two types of fluids that might abnormally build up in the pleural space:

  • Transudate: an increase in hydrostatic pressure and a decrease in colloid osmotic pressure in the chest
  • Exudate: typically produced by inflammatory conditions such as lung infection and malignancy

There are many conditions that may cause pleural effusion:

  • Congestive heart failure
  • Kidney failure
  • Infection
  • Malignancy
  • Pulmonary embolism
  • Hypoalbuminemia
  • Cirrhosis
  • Trauma

Pleural effusion may have the following common symptoms :

  • chest pain
  • difficulty breathing
  • pleurisy or painful breathing
  • either a dry cough or a productive cough
  • presence of fever, chills, and loss of appetite

Diagnosis and Treatment

To properly diagnose if you have the disease, your doctor will review your medical history and conduct one or more of the following physical exams or test:

  • Check for dullness to percussion or sound of the lung area when being tapped with a finger. The percussion or sound is dull if there is fluid accumulation and sound will be lighter if no fluid exists in the area
  • Check for decreased vibration in the chest area
  • Asymmetrical chest expansion or the lungs do not inflate or deflate equally
  • Use of a stethoscope may indicate reduced or inaudible breath sounds on the affected side
  • Egophony, which is where the patient says the letter "e," but when listening, it sounds like "a"
  • A friction rub, which is if there is fluid in the pleural area, the heart will rub against the inflamed or fluid-filled space

Your doctor will most likely order for a chest X-ray for you to see if there is a pleural effusion. If present, this would normally be a whitish area in the lungs on one or both sides. Your doctor may also order for a CT scan or ultrasound to further identify the possible cause and extent of pleural effusion. It is important that if there is any abnormal amount of fluid present in the lungs, it can be quickly determined if the fluid is transudate or exudate because this will determine the course of treatment for your condition:

  • Thoracentesis: can remove large amounts of fluid, effectively treating many pleural effusions
  • Tube thoracotomy or chest tube: A small incision is made in the chest wall and a plastic tube is inserted into the pleural space to suction out the fluid, and is often kept in place for several days
  • Pleurodesis: An irritating substance (such as talc or doxycycline) is injected through a chest tube into the pleural space which inflames the pleura and chest wall and then binds tightly to each other as they heal. This can prevent pleural effusions from recurring, in many cases
  • Pleural drain: for pleural effusions that recur repeatedly, a long-term catheter can be inserted through the skin into the pleural space. A patient with a pleural catheter can drain the pleural effusion periodically at home
  • Pleural decortication: Your doctor can operate inside the pleural space, removing potentially dangerous inflammations and unhealthy tissue. It may be performed using small incisions (thoracoscopy) or a large one (thoracotomy)

Antibiotics may be given should there be any infection. Remember to adhere to your doctor’s orders when taking medications. Know the names of your medications, what they are for, and how often to take them.

What to Expect

You will be given information about where to go and when to arrive. When you arrive, you will be taken to a pre-surgery area so that we can take your temperature, blood pressure, pulse, and listen to your heart and lungs.

Your procedure may either take an hour depending on the kind of procedure you will have.


Before you go home, your nurse will teach you how to use any equipment you might need, how to care for your incision, and review your medications with you. Gradually, over the course of a few weeks, you will regain your strength and can return to work and participate in physical activity. Be sure to call your doctor if you notice any of the following:

  • Bleeding
  • Infection
  • High temperature
  • Allergic reaction, such as redness, swelling or trouble breathing
  • Pain

Always take your medicine exactly as prescribed. Call your doctor if you have any questions or changes.