What Is a Pleural Effusion? | Causes | Symptoms | Diagnosis | Treatments | Get Support

Fluid in the lungs can develop as a result of lung cancer treatment or lung cancer itself. Known as a pleural effusion, this buildup of fluid is a fairly common condition. Its symptoms can range in severity, and there are several treatment options.

Many MyLungCancerTeam members have shared their experiences with pleural effusions, describing their symptoms and sharing tips on how they manage the condition. Learn more about what causes fluid in the lungs and how it’s treated.

What Is a Pleural Effusion?

A pleural effusion is the buildup of excess fluid in and around the lungs, specifically in the area known as the pleural cavity. The pleura is a two-layer membrane that surrounds the lungs. The outer layer attaches to the chest wall, while the inner layer covers the lungs. The thin space between the two layers is known as the pleural cavity (or pleural space).

Normally, there is only about one teaspoon of fluid in the pleural space. However, in diseases like lung cancer, more fluid can build up in this area and make it difficult to breathe. When a pleural effusion is caused by cancer, it is known as a malignant pleural effusion.

What Causes a Pleural Effusion?

Pleural effusions are extremely common and can be caused by many conditions. In the United States, more than 1.5 million cases are diagnosed every year. In the case of lung cancer, pleural effusions can be caused by tumors or by treatments used to fight cancer such as chemotherapy and radiation therapy.

Other causes of a pleural effusion can include:

• Other types of cancer, including lymphoma, breast cancer, and mesothelioma
• Congestive heart failure
• Chest infections such as pneumonia or tuberculosis
• Cirrhosis, which is scarring of the liver
• Blood clots in the lungs

There are two types of pleural effusion, categorized based on how much protein is found in the fluid. Pleural effusions caused by lung cancer are typically known as exudative pleural effusions, and they have high levels of protein in the pleural fluid. The other type, transudative pleural effusions, have low levels of protein.

Symptoms of Pleural Effusion

Pleural effusion symptoms will vary person to person. Some people may not experience any symptoms, but common symptoms can include:

• Shortness of breath (known as dyspnea), either while at rest or moving
• Chest pain
• Pressure in the chest
• Dry cough
• Fatigue
• Fever
• Pain or discomfort while taking a deep breath
• Difficulty breathing unless sitting or standing up (known as orthopnea)

MyLungCancerTeam members have described how their pleural effusions feel. “A lot of pain, discomfort, coughing, and shortness of breath,” wrote one member. “It’s always worse at night,” shared another.

However, other members have not experienced any symptoms. “My scan shows a large pleural effusion,” reported one. “But I am not short of breath.”

Diagnosing Pleural Effusion

Sometimes, pleural effusion can be found during routine testing for lung cancer, most often with a chest X-ray. Other times, you may go to your doctor with symptoms, and they’ll run a series of tests to confirm a diagnosis. These may include a physical examination, imaging tests, and a thoracoscopy.

Imaging Tests

In order to visualize the lungs, your doctor may perform a CT scan. This test gives detailed images of the inside of the body, which can help your doctor determine if there’s any fluid in the lungs. Your doctor may have you swallow a dye or inject it into your vein to help them see the lungs more clearly.

An ultrasound can also help diagnose pleural effusions. This imaging method uses sound waves that bounce off the lungs and other organs in the chest cavity and echo back, then are read by a computer. The computer creates images of the chest and lungs based on the echoes.

Thoracoscopy

A thoracoscopy allows your doctor to view inside the chest and lungs to look for fluid, any other signs of lung cancer, or other complications. During the procedure, a health care professional makes a small cut between two ribs, then inserts a long, thin tube with a light and camera attached to the end (known as a thoracoscope) into the cut. During this procedure, your doctor may also take a tissue sample (biopsy), which they can use to look for cancer cells.

Thoracentesis

During a thoracentesis, a health care professional inserts a needle into a numbed area of the chest to drain the fluid from the pleural space. Your doctor may collect a sample of fluid to look for cancer cells. This procedure is also used as a treatment for pleural effusions.

Treatments for Pleural Effusion

There are several treatment options for pleural effusions, including draining the excess fluid and medications to help the body get rid of water. In some cases, the treatments may only be needed once, and in others, they are repeated to help keep fluid out of the lungs.

Treatments for a pleural effusion include:

• Thoracostomy
• Thoracentesis
• Pleurodesis
• Catheter placement
• Medications such as diuretics (water pills)

Read more about these treatments below.

Thoracostomy

A thoracostomy is a procedure that involves placing a hollow plastic tube, known as a chest tube, into the space between the ribs to drain fluid. Once the chest tube is in place, it can be used to drain fluid multiple times. Medications can also be given through it to help prevent fluid from building back up.

Thoracentesis

A thoracentesis involves inserting a long needle into a numbed area into the chest cavity and pleural layers to help drain fluid. On MyLungCancerTeam, this is a common treatment for those living with pleural effusions. One member shared about their thoracentesis: “I recently had 1.6 liters removed. It was instant relief! It’s not really a painful procedure.”

A thoracentesis is typically only a temporary solution to pleural effusions because fluid tends to build up again in a few days.

Pleurodesis

Once the fluid is removed via thoracentesis or thoracostomy, your doctor may have you undergo another procedure, known as pleurodesis, to keep the fluid from returning. There are two main types: surgical pleurodesis and chemical pleurodesis.

Surgical pleurodesis is done using a thoracoscopy. When the instrument is inserted through the incision, it blows a powdery substance known as talc into the pleural space around the lungs. This helps stop fluid from building up again.

Chemical pleurodesis is done by using a chest tube (likely left in the chest from a thoracostomy). Substances like talc, medications such as chemotherapy (bleomycin, for example), or antibiotics (such as doxycycline) are inserted into the tube. These cause the pleural layers to stick together, closing the space between them so fluid cannot collect in that area.

Catheter Placement

Another treatment option for pleural effusions is an indwelling pleural catheter (IPC). An IPC is a small, thin, flexible tube that is inserted under the skin and into the pleural space to help drain excess fluid. The catheter is placed during an outpatient procedure. Your skin will be numbed before the catheter is inserted.

Once the catheter is placed, you can go home and continue to drain the fluid with no more needles or other procedures. It is typically in place as long as it is helpful and effective in removing the fluid.

Diuretics

Diuretics are a type of medication that helps the body remove excess water. These can help treat pleural effusions caused by congestive heart failure and some other conditions. However, they’re rarely effective in managing pleural fluid buildup caused by cancer itself.

One MyLungCancerTeam member wrote, “Dealing with pleural effusion. Pretty scary. Taking water pills and hoping it will take the water away.”

Talk With Others Who Understand

MyLungCancerTeam is the social network for people with lung cancer and their loved ones. On MyLungCancerTeam, more than 6,400 members come together to ask questions, give advice, and share their stories with others who understand life with lung cancer.

Have you had a pleural effusion? What did it feel like, and how was it treated? Share your experience in the comments below, or start a conversation by posting on your Activities page.