The thin lining of the lungs is called pleura and it produces small amount of fluid to lubricate the lungs. Accumulation of excess fluid around the lungs in the lung linings due to any cause leads to decreased lung volume, breathing difficulty and chest pains. This fluid can be infected pus (empyema) or reactive fluid due to fluid imbalance in the body (pleural effusion), or blood in case of trauma (hemothorax).

What are the symptoms of pleural effusion?

Breathing difficulty, chest pain that improves on lying on the affected side and decreased chest movements in the backdrop of high-grade fever with or without chills and cough is typical of empyema. These children often have decreased air entry into the affected side on examination.

What causes pleural effusion?

• Infection – parapneumonic effusions and empyema are common
• Tuberculosis
• Trauma
• Malignancy
• Lymphatic disorders
• Heart failure
• Post-surgery complication

How is pleural effusion diagnosed?

Radiological imaging: Chest X-rays are a good way to determine if there is pleural effusion. It also tells us if there is any pneumonia in the lungs. Sometimes a CT chest maybe required to look at the extent and severity of the effusion and to check the other parts of the lungs.

Pleural fluid analysis: Pleural fluid can be aspirated from the lungs by a procedure called thoracocentesis. A small needle is inserted along with a syringe into the pleura and fluid is aspirated. This fluid is then tested further for the type of cells, culture etc. This gives the doctor more information on the cause of pleural effusion.

How do we treat pleural effusion?

Treatment depends on the type of pleural effusion and the amount of fluid that is collected.

In large quantity pleural effusions causing severe symptoms-

• An intercostal tube is inserted into the pleural cavity to drain out the pleural fluid.
• Antibiotics for treating infection

Treatment of underlying cause is done along with pleural fluid drainage. In some cases of empyema, the fluid may be accumulated in loculations and these cases might require surgical interventions for proper drainage.

Are there any long-term concerns of pleural effusion?

There are no long-term consequences of pleural effusion after it is completely drained and underlying cause is treated. Although, it can sometimes lead to further complications like bronchopulmonary fistulas, recurrence of effusion, or persistent lung collapse.