Types of Pleural Effusions
There are two main categories of pleural effusions:
Uncomplicated pleural effusion: The pleural effusion contains fluid that is free of serious inflammation or infection. If large enough, an uncomplicated pleural effusion can cause symptoms. However, these pleural effusions rarely cause permanent lung problems.
Complicated pleural effusion: A 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, usually with a tube placed into the chest.
Doctors also use the terms transudative and exudative to describe pleural effusions:
Transudative: The pleural effusion fluid is similar in character to the fluid normally present in the pleural space. Transudative pleural effusions rarely require drainage, unless they are very large. Congestive heart failure is an example of a condition that can cause a transudative pleural effusion.
Exudative: The pleural effusion fluid has excess protein, blood, or evidence of inflammation or infection. An exudative pleural effusion may require drainage, depending on its size and the severity of inflammation. Causes of exudative pleural effusion include pneumonia and lung cancer.
The type of pleural effusion can only be identified by taking a sample of fluid from the pleural effusion.
Treatment of Pleural Effusions
Treatment for pleural effusions may often simply mean treating the medical condition causing the pleural effusion. Examples include giving antibiotics for pneumonia, or diuretics for congestive heart failure.
Large, infected, or inflamed pleural effusions often require drainage to improve symptoms and prevent complications. Various procedures may be used to treat pleural effusions, including:
Thoracentesis (described above) can remove large amounts of fluid, effectively treating many pleural effusions.
Tube thoracotomy (chest tube): A small incision is made in the chest wall, and a plastic tube is inserted into the pleural space. Chest tubes are attached to suction and are often kept in place for several days.
Pleurodesis: An irritating substance (such as talc or doxycycline) is injected through a chest tube, into the pleural space. The substance inflames the pleura and chest wall, which then bind tightly to each other as they heal. Pleurodesis can prevent pleural effusions from recurring, in many cases.
Pleural drain: For pleural effusions that repeatedly recur, a long-term catheter can be inserted through the skin into the pleural space. A person with a pleural catheter can drain the pleural effusion periodically at home.
Pleural decortication: Surgeons can operate inside the pleural space, removing potentially dangerous inflammation and unhealthy tissue. Decortication may be performed using small incisions (thoracoscopy) or a large one (thoracotomy).