Pleural Effusion

Original Editor - Chelsea McLene

Top Contributors - Chelsea Mclene, Rosie Swift and Kim Jackson  

Introduction

Pleural effusion is collection of unusual amount of fluid in pleural cavity. 

(Read about Pleura here)

When there's a pleural effusion, fluid builds up in the space between the layers of pleura.

Normally, for smooth movement of lungs, only teaspoons of watery fluid are in the pleural space.

Classification

By Pathophysiology

Transudative

Transudative type of pleural effusion rarely needs to be drained. It is formed from the liquid which leaks around the pleura.

Most common cause of this type is congestive heart failure.

• Less protein
• Few cells

Exudative

Exudative type of pleural effusion requires to be drained. It is formed from extra liquid, protein, blood, inflammatory cells or sometimes bacteria that leak across damaged blood vessels into the pleura.

The causes of this type include pneumonia and lung cancer.

• More protein
• Large amount of cells

By the origin of the fluid

• Serous fluid (hydrothorax)
• Blood (haemothorax)
• Chyle (chylothorax)
• Pus (pyothorax)
• Urine (urinothorax)

Symptoms

• May or may not have fever
• May have cough
• Breathlessness
• Chest pain
• Pleural rub
• Heart Sounds: Third heart sound can be heard.
• Weakness

Causes

There are many causes, some of them are:

• Leak from other organs
• Autoimmune conditions: RA, Lupus
• Cancer
• Pulmonary embolism

Diagnosis

• Blood Test: Neutrophilia
• CT Scan
• X-ray: Presence of fluid in the pleural cavity which appears white on X-rays, while air space looks black.

Treatment

The principle treatment approach with pleural effusion is to treat the underlying cause.

• Medication: Antibiotics, Diuretics
• Pleural Decortication: Surgeons can operate inside the pleural space, removing inflammation and unhealthy tissue by thoracoscopy or thoracotomy.
• Chemotherapy
• Thoracentesis
• Pleural Biopsy
• Drainage by intercostal tubes
• Pleurodesis

Role of Physiotherapy

Physiotherapy has an important role in stabilizing and controlling breathing. It aids in chest fluid drainage and in clearing chest secretions. People who receive respiratory physiotherapy as part of their treatment will tend to achieve a quicker recovery with fewer complications.

• 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:
  • Illness cause and progression.
  • Effects of environmental and allergen factors.
  • Medication management

(Read about chest physiotherapy)