01. Overview
What Is Pleural Effusion?
Pleural effusion happens when extra fluid collects within the lining around the affected lung (the pleura). The pleura has two layers. In healthy people, the area between the layers (the pleural space) holds a small amount of fluid. This helps the layers slide smoothly when you breathe. Effusion occurs when fluid builds up beyond the normal amount.
Several conditions can trigger this buildup of excess pleural fluid, including mesothelioma. If enough fluid collects, it can press on the lung, making it difficult to breathe. Doctors may recommend draining the effusion to relieve this symptom.
02. Mesothelioma
Mesothelioma and Pleural Effusion
Pleural effusion is a common symptom of malignant pleural mesothelioma. Research suggests more than 95% of patients experience pleural effusion at some point. For many, it is the first noticeable sign of mesothelioma.
Pleural mesothelioma triggers effusion by increasing pleural fluid production and slowing its drainage. Tumor cells draw extra liquid into the pleural space. Mesothelioma cells can also spread to and block flow in the lymph nodes. This slows lymphatic drainage, causing pleural fluid to collect.
Many other conditions can lead to pleural effusions. This means fluid buildup can be triggered in different ways depending on the root cause.
03. Causes
Causes of Pleural Effusion
Heart failure, cancer and pneumonia are the most common causes of pleural effusions. These illnesses trigger effusion by increasing pleural fluid, decreasing its drainage or both. Other conditions can also cause pleural effusions.
Pleural effusions may be malignant or benign, depending on the cause. Malignant pleural effusions are caused by cancer. Benign pleural effusions are caused by illnesses that are not cancer. Treatment options differ between these two effusion types.
Pleural effusions can also be categorized by the contents of the effusion fluid:
- Protein-rich: This type of effusion contains a lot of protein and may be called an exudative effusion. It may be caused by cancers or inflammatory conditions. Protein-rich effusions are common among mesothelioma patients.
- Watery: This type of effusion is considered protein-poor and may be called a transudative effusion. It may be caused by heart failure, cirrhosis or pulmonary embolisms.
Understanding the protein content of an effusion may help doctors pinpoint its cause. This information can also affect treatment options.
Asbestos-Related Pleural Effusion
Asbestos exposure may increase your risk of developing pleural effusion. Once inhaled, asbestos fibers can cause inflammation and illness, including effusions. In rare cases, exposure can cause benign asbestos pleural effusion (BAPE).
BAPE occurs when a patient has pleural effusion with no other cause except asbestos exposure. Patients with BAPE do not necessarily have mesothelioma but may develop it in the future.
04. Symptoms
Symptoms of Malignant Pleural Effusion
Pleural effusion commonly signals the presence of another condition. But the fluid buildup can cause its own symptoms. Pleural effusion symptoms include shortness of breath, chest pain, coughing and fatigue. Some patients may not have symptoms. In these cases, the effusion may be found incidentally.
Note: Malignant and benign pleural effusions may cause similar symptoms.
Symptoms can range from mild to severe based on the amount of fluid in the pleural space. The greater the amount of fluid, the more noticeable symptoms may become.
05. Diagnosis
How Is Pleural Effusion Diagnosed?
Doctors use several tests to investigate cases of suspected pleural effusion. Tests can include imaging scans like chest X-rays, ultrasound or CT scans. Doctors can also perform a physical exam.
To find the cause of pleural effusion, physicians may prescribe additional tests. For example, patients may undergo a biopsy to retrieve a sample of the effusion fluid. Technicians can analyze this fluid to help narrow down the underlying cause of fluid buildup.
Tests that can provide information on the cause of an effusion include:
These procedures may help doctors diagnose the root cause of pleural effusion and recommend an appropriate treatment.
Early Detection of Pleural Effusion Can Help Mesothelioma Patients
Early detection of pleural effusion may also lead to an early mesothelioma diagnosis.
Some patients with benign pleural effusion and past asbestos exposure may later develop pleural mesothelioma. In these cases, doctors can continue to monitor the patient for signs of mesothelioma. This may help with early diagnosis.
Earlier diagnosis generally comes with a more favorable mesothelioma prognosis. But life expectancy also depends on a patient’s cell type, age, overall health and other factors.
06. Treatment
How Is Pleural Effusion Treated?
Pleural effusion treatments target the root cause. Doctors may treat effusions from heart failure with diuretics. Antibiotics treat infection-related effusions. Malignant pleural effusions are often treated by draining the fluid. Some approaches also aim to prevent future effusions.
Doctors treat pleural effusions in mesothelioma patients with short- or long-term solutions. Short-term approaches entail one-time drainage of excess fluid. Long-term options allow for repeated fluid drainage or seek to prevent future buildup.
Patients can receive these treatments alongside others, like immunotherapy or palliative care.
Pleural Effusion Treatment Options
Like all medical treatments, each option comes with its own risks and benefits. Patients should discuss these factors with a mesothelioma specialist. The doctor can explain which choices best fit an individual patient.
07. Common Questions
Common Questions About Pleural Effusion
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Can pleural effusion go away?
- Minor pleural effusions may go away without treatment. More serious effusions can also go away with treatment. If treatment can address the cause of the effusion, it is more likely to resolve.
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Who is more likely to get a pleural effusion?
- People who smoke or drink alcohol may have a higher than average risk of developing pleural effusion. This is because smoking and drinking can cause heart, lung and liver problems, which can trigger effusion.
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Is pleural effusion curable?
- Doctors can treat pleural effusions. They may be able to cure some cases by treating the underlying cause. If the underlying cause cannot be treated, the effusion may require repeat treatment. Patients should discuss treatment options with their doctors to understand the likelihood of a cure.
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What is the best treatment for pleural effusion?
- For malignant pleural effusions, data indicates talc pleurodesis is the most effective chemical-based treatment. The best treatment for pleural effusion depends on the cause and patient factors. Doctors can weigh these variables and advise the best approach.
