Pulmonary Edema Treatment in Delhi | Fluid in Lungs Specialist

Pleural Effusion/Pleurisy (fluid outside Lungs)

Pleural Effusion refers to the accumulation of fluid in the pleural space, the thin area between the lungs and the chest wall. Pleurisy (or pleuritis) is the inflammation of the pleura, often associated with pain, and can sometimes lead to pleural effusion.

The pleura has two layers:

Visceral pleura – It covers the lungs
Parietal pleura – This lines the chest wall

Usually, a small amount of fluid (5–15 mL) helps to lubricate the lungs during breathing. But in pleural effusion, excess fluid builds up, making breathing difficult and potentially compressing the lungs.

Causes of Pleural Effusion

Pleural effusions can be transudative (due to imbalance in pressure) or exudative (due to inflammation or infection). Common causes include:

Transudative Causes:

Congestive Heart Failure (CHF) – most common
Liver cirrhosis (hepatic hydrothorax)
Nephrotic syndrome
Pulmonary embolism

Exudative Causes:

Pneumonia (Parapneumonic effusion)
Tuberculosis
Malignancy (Lung or breast cancer)
Autoimmune diseases (e.g., lupus, rheumatoid arthritis)
Pulmonary embolism
Post-surgery or trauma

Symptoms of Pleural Effusion / Pleurisy

Shortness of breath (especially while lying down)
Sharp chest pain (worse during deep breathing or coughing – typical in pleurisy)
Dry cough
Fever and chills (in infection-related effusion)
Fatigue
Reduced chest expansion on the affected side

Diagnosis

Clinical Evaluation:

Chest exam may reveal: Dullness on percussion, decreased breath sounds, and reduced chest movement.

Imaging:

Chest X-ray – It determines the blunted costophrenic angle, fluid level
Ultrasound chest – Helps to detect small amounts of fluid, guides aspiration
CT scan – This provides detailed view, especially for cancer or infection

Diagnostic Thoracentesis:

Needle aspiration of pleural fluid for analysis: It tells the cell count, Protein and LDH levels (Light’s criteria for transudate vs. exudate), Cytology (for malignancy), Culture & Gram stain (for infections)

Treatment of Pleural Effusion

Therapeutic Thoracentesis – To relieve the symptoms and drain fluid.
Chest tube insertion (intercostal drainage) – For large or recurrent effusions.
Pleurodesis – It is a procedure to stick the lung to the chest wall to prevent fluid’s re-accumulation (commonly used in cancer).

Frequently Asked Questions (FAQs)

1. Is pleural effusion the same as water in the lungs?

No, not exactly pleural effusion is the fluid which is around the lungs, while pulmonary edema is fluid inside the lung tissue.

2. Can pleural effusion come back after the treatment?

Yes, especially if the underlying cause like cancer, TB, or heart failure is not fully controlled. Recurrent effusions may require long – term drainage or pleurodesis.

3. Is pleural effusion painful?

It can be, especially if pleurisy is involved. The sharp pain worsens with deep breaths or coughing.

4. Is hospitalization needed for pleural effusion?

No, not always. Small, stable effusions might be managed as outpatients. Large or infected effusions usually require hospital treatment.