Key Takeaways
- A pleural effusion — sometimes called “water on the lungs” — is a buildup of excess fluid between the thin membranes (pleura) that line the lungs. While a small amount of fluid in the pleura is normal, too much can cause serious problems.
- Symptoms include dry cough, chest pain, shortness of breath (dyspnea), and difficulty breathing unless sitting up or standing (orthopnea). Some people may not experience symptoms at all. Severe cases carry a risk of collapsed lung.
- Pleural effusions can be caused by asbestos exposure and are commonly associated with mesothelioma and other asbestos-related diseases.
- Diagnostic tests include chest X-ray, CT scan, ultrasound, thoracentesis (needle removal of fluid), pleural fluid analysis, and in some cases VATS (video-assisted thoracic surgery) for direct visual examination.
- Treatment options depend on the cause and severity — ranging from catheter drainage and tunneled pleural catheters (TPCs) for ongoing drainage, to surgery (VATS or thoracotomy), chemotherapy, radiation, and medication to prevent fluid from building up again.
Pleural effusions are a buildup of fluid in the lining of the lung, leading to chest pain, coughing, difficulty breathing and high risk of collapsed lung. This is sometimes called “water on the lungs.” In the body, the pleura are thin membranes that line the lungs. It is normal for a small amount of fluid to be in the pleura, but when the fluid gets to be too much, it is problematic.
Symptoms
Pleural effusions have varying degrees of severity, depending on the cause of the effusion. Some people who experience pleural effusions may not experience symptoms while others may. However, symptoms include a dry, nonproductive cough, chest pain, dyspnea, which is shortness of breath, or difficult, labored breathing, and orthopnea, which is the inability to to breathe easily unless the person is sitting up or standing up straight. Pleural effusions can be caused by exposure to asbestos.
Testing
There are a multitude of tests that can be done to diagnose pleural effusions. These tests include an ultrasound of the chest, a CT scan of the chest, a chest x-ray, thoracentesis, which is when a needle is inserted to remove a sample of fluid, and a pleural fluid analysis, which is an examination of the fluid removed from the pleura. A CT scan allows doctors to do many different things. These include planning radiation therapy for cancer treatment, finding the right place for a biopsy, and learning the stage of cancer, which allows the doctor to determine which treatment options are best for the patient. A CT scan involves taking pictures of the inside of the body using x-rays. These x-rays are taken from a variety of different angles. After these tests, if the pleural effusion has still not been diagnosed, another test can be done. This test is called a thoracoscopy and it is minimally invasive. It is also known as video-assisted thoracic surgery, or VATS. This test allows for the pleura to be seen on video.
Treatment
Treatment for pleural effusions depends on aspects such as symptoms and the cause of the effusion. If the effusion cannot be drained, the patient may require surgery. The two types of surgery used to treat pleural effusions are VATS and thoracotomy. In some cases, treatment may involve chemotherapy, radiation therapy, putting medicine into the chest to stop fluid from building up again once it has been drained and leaving a small sized tube in place for a period of time in order to let the fluid drain and for the lung to expand throughout time.
Other treatment options may include using a catheter and a shunt. A catheter may be used to drain the fluid from the pleura. A catheter is a thin tube of plastic that is put into the pleural fluid. Another form of a catheter that may be utilized is called a tunneled pleural catheter (TPC), which can be inserted and left in the lungs for a long period of time to allow for continued drainage. A shunt is inserted during surgery and is used to pass and divert extra fluid from one place to another.
If you or a loved one has been diagnosed with mesothelioma or another asbestos-related disease, call (800) 505-6000 today. For more information, fill out our contact form.
Frequently Asked Questions
What is a pleural effusion?
A pleural effusion is a condition in which excess fluid accumulates between the two thin membranes (pleura) that line the lungs. It is sometimes referred to as “water on the lungs.” A small amount of fluid in the pleural space is normal and helps the lungs move smoothly during breathing, but when too much fluid builds up, it can compress the lungs and cause chest pain, coughing, and difficulty breathing.
What are the symptoms of a pleural effusion?
Symptoms vary in severity depending on the cause and the amount of fluid buildup. Common symptoms include:
- Dry, nonproductive cough
- Chest pain
- Dyspnea — shortness of breath or difficult, labored breathing
- Orthopnea — inability to breathe easily unless sitting upright or standing
In some cases, patients may have a pleural effusion without experiencing any noticeable symptoms, which is why diagnostic testing is important.
Can asbestos exposure cause pleural effusions?
Yes. Pleural effusions can be caused by exposure to asbestos and are commonly seen in patients with mesothelioma and other asbestos-related diseases. When asbestos fibers become embedded in the pleural lining, they can cause inflammation and damage that leads to abnormal fluid buildup. A pleural effusion may be one of the earliest signs of pleural mesothelioma, making it especially important for anyone with a history of asbestos exposure to seek prompt medical evaluation if they experience symptoms.
How are pleural effusions diagnosed?
Several tests can be used to diagnose a pleural effusion:
- Chest X-ray — can reveal fluid buildup around the lungs
- CT scan — provides detailed cross-sectional images that help doctors locate fluid, plan biopsies, determine cancer staging, and guide radiation therapy
- Chest ultrasound — uses sound waves to visualize fluid in the pleural space
- Thoracentesis — a needle is inserted into the pleural space to remove a sample of fluid for testing
- Pleural fluid analysis — laboratory examination of the removed fluid to determine its cause
- VATS (video-assisted thoracic surgery) — a minimally invasive procedure that allows doctors to see the pleura directly on video, used when other tests have not provided a clear diagnosis
How are pleural effusions treated?
Treatment depends on the cause and severity of the effusion. Options include:
- Catheter drainage — a thin plastic tube is inserted to drain fluid from the pleural space
- Tunneled pleural catheter (TPC) — a catheter left in place for an extended period to allow ongoing drainage
- Shunt placement — surgically inserted to redirect excess fluid from one area to another
- Surgery — VATS or thoracotomy may be used when the effusion cannot be drained through less invasive methods
- Pleurodesis medication — medicine placed into the chest cavity to prevent fluid from building up again after drainage
- Chemotherapy or radiation therapy — used when the effusion is caused by cancer
What is a tunneled pleural catheter (TPC)?
A tunneled pleural catheter is a small, flexible tube that is inserted into the pleural space and left in place for an extended period. It allows for repeated drainage of fluid without requiring a new needle insertion each time. TPCs are often used for patients with recurring pleural effusions — such as those caused by mesothelioma — where fluid continues to build up over time and needs to be managed on an ongoing basis.
Can a pleural effusion be a sign of mesothelioma?
Yes. A pleural effusion is one of the most common early symptoms of pleural mesothelioma. When mesothelioma develops in the lining of the lungs, it can cause inflammation and irritation that leads to excess fluid production. If you have a history of asbestos exposure and develop symptoms like unexplained shortness of breath, chest pain, or persistent cough, it is important to mention your exposure history to your doctor so appropriate testing can be performed.
What should I do if I have a history of asbestos exposure and am experiencing symptoms of a pleural effusion?
If you or a loved one has a history of asbestos exposure and is experiencing symptoms such as chest pain, shortness of breath, or persistent cough, seek medical attention as soon as possible. A pleural effusion can be an early indicator of mesothelioma, and early detection is critical for expanding treatment options. For information about your legal options, call (800) 505-6000 or fill out our contact form.
