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Pleural Effusions

the thoracic cavity with dr presser
Dr. Presser

Dr. Presser

The #1 reason why people seek acute medical attention is because they can’t breathe. Most people will walk around in pain, but if you cannot breathe it’s pretty scary.

Pleural effusion, an abnormal amount of fluid around the lung(s), is one of the conditions that affect a person’s ability to breathe easily.

Causes. The pleura is a thin membrane that lines the surface of the lungs and the inside of the chest wall outside of the lungs. In pleural effusions, fluid accumulates in the space between the layers of pleura. Normally, only teaspoons of watery fluid are present in the pleural space, allowing the lungs to move smoothly within the chest cavity during breathing. Numerous medical conditions can cause pleural effusions such as cancer, pneumonia, liver and kidney disease, and congestive heart failure which affect the body’s ability to handle fluid properly.

Symptoms are more likely when a pleural effusion is moderate or large-sized, or if inflammation or pneumonia is present. They may include shortness of breath, chest pain (especially when breathing in deeply), fever or cough.

Diagnosis of Pleural Effusions. Usually your doctor can hear decreased breath sounds on the side of your chest affected. A CXR, Ultrasound or a CT chest scan should be ordered to better evaluate the problem. Once it is established you have fluid surrounding your lung, you need to know your options. A fluid sample is usually taken to determine the pleural effusion’s character and seriousness. In a procedure called thoracentesis, a doctor inserts a needle and a catheter between the ribs, into the pleural space. A small amount of fluid is withdrawn for testing; a large amount can be removed simultaneously to relieve symptoms.

Types of Pleural Effusions. There are two main categories of pleural effusions: Uncomplicated pleural effusion contains fluid that is free of serious inflammation or infection. If large enough, an uncomplicated pleural effusion can cause symptoms. Complicated pleural effusion contains fluid that has significant inflammation or infection. If untreated, complicated pleural effusions may harden to form a constricting ring around the lung. This hardening process, called organization, can permanently impair breathing. To prevent organization, complicated pleural effusions require drainage.

Single Incision Chest Surgery. By making a single, one centimeter incision in the chest under local anesthetic with light sedation, we can introduce a small camera to drain the fluid in its entirety. We are also able to take biopsies as needed and, most importantly, directly exam the lung and chest cavity to determine what the best option is during the procedure.

Minimally invasive chest surgery makes a difference in these cases. I’ve had numerous patients tell me how much better their life is now that they can breathe easier. What’s most important is obtaining a proper diagnosis and understanding your options.

Dr. Presser is a thoracic surgeon specializing in minimally invasive procedures. He is an advocate for prevention and encourages lung cancer screenings which are proven to save lives. He welcomes your questions and can be reached at 760.424.8224. 

2 Responses to “Pleural Effusions”

  1. Candy says:

    What test are there for complicated pleural effusion? And how do you treat a constricting ring around the lung?

    • Dr. Presser says:

      Candy: Complicated or complex pleural effusions are how we usually describe how they look on CT scan. If the effusion is sampled via thoracentesis you should know if it is a transudate or an exudate. Pleural effusions and their effect on the lung need to be addressed on a case by case basis. If a lung is constricted or has a “peel” around it caused by infection, this is handled differently than if caused from cancer. Most complex effusions need to be dealt with surgically and I perform thoracoscopy under local and some sedation when necessary. I could give you a much more focused answer with more information but I hope this helps. Do not hesitate to call my office anytime.

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