Learning you have fluid in your lungs can be scary, especially when it makes breathing difficult. If this happens to you, it can help to know more about it and what to expect.

Called pleural effusion, fluid is fairly common in people with lung cancer and can be caused by the disease itself or some treatments. Symptoms of pleural effusion can be different for everyone, and there are several ways to treat it.

Many MyLungCancerTeam members have shared their experiences with pleural effusions, describing their symptoms and sharing tips on managing the condition. Learn more about pleural effusions, including what they can feel like, what causes them, and how they’re treated.

What Is a Pleural Effusion?

A pleural effusion is the buildup of excess fluid 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 the pleural cavity (or pleural space).

Normally, there is only a small amount of fluid (about 1 teaspoon) in the pleural space. However, in pulmonary diseases like lung cancer, more fluid can build up in this area, making it difficult to breathe. When cancer causes a pleural effusion, it’s known as a malignant pleural effusion.

What Causes a Pleural Effusion?

Pleural effusions are extremely common and can be caused by many conditions. Each year, more than 1.5 million cases are diagnosed in the United States. Tumors and treatments used to fight cancer, such as chemotherapy and radiation therapy, are common causes of pleural effusions associated with lung cancer.

Other causes of pleural effusion include:

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

There are two types of pleural effusion, categorized by how much protein is found in the fluid: transudative versus exudative pleural effusion.

Pleural effusions caused by lung cancer are typically categorized as exudative pleural effusions, which have high levels of protein in the pleural fluid.

The other type, transudative pleural effusions, have low levels of protein and are commonly caused by noncancerous diseases.

Symptoms of Pleural Effusion

Pleural effusion symptoms are different in everyone. 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, sharing noticeable symptoms. “A lot of pain, discomfort, coughing, and shortness of breath,” wrote one member.

“It’s always worse at night,” shared another, demonstrating the difficulty in figuring out how to sleep with fluid in the lungs.

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, a pleural effusion can be found during routine testing for lung cancer, most often with a chest X-ray. Other times, if you have symptoms caused by a pleural effusion, your doctor will run a series of tests to confirm a diagnosis such as a physical examination or imaging tests.

Imaging Tests

Your doctor may perform a CT scan to see what’s happening in your lungs. This test gives detailed images of the inside of the body, which can help your doctor determine if there’s any fluid in your lungs. Your doctor may have to inject a dye into your vein to help them see your 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 (also called the thoracic 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 see the inside of the chest and lungs and check for fluid, any other signs of lung cancer, or other complications. During the procedure, your doctor 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. Your doctor may also perform a biopsy (take a tissue sample), which they can use to look for cancer cells.

Thoracentesis

During a thoracentesis, your doctor 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 removing fluid from lungs and taking medications to help the body get rid of water. In some cases, treatments may only be needed once. In others, ongoing treatment may be required to keep fluid out of the lungs.

Pleural effusion treatments include:

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

Thoracostomy

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

Thoracentesis

A thoracentesis involves inserting a long needle into the chest cavity and pleural layers to help drain fluid. The area is numbed for the procedure. Many MyLungCancerTeam members living with pleural effusions have undergone a thoracentesis. One member shared their experience: “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 a pleurodesis, to keep the fluid from returning. There are two main types: surgical pleurodesis and chemical pleurodesis.

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

Chemical pleurodesis is a treatment that uses a tube in the chest to stop fluid from collecting in the lungs. This tube might already be in place from an earlier 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 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’s typically in place as long as it’s helpful and effective in removing the fluid. Talk to your doctor about what to expect from having the IPC at home, like what color should fluid drained from lungs be, and any concerns to watch out for.

Diuretics

Diuretics are a type of medication that helps the body remove excess water. Diuretics 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.

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

Talk to your health care team if you have questions about treatment for pleural effusions or other concerns about living with a pleural effusion, such as how to manage pleural effusion treatments at home.

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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.