Restoring respiratory function in patients with pleural effusion

August 15, 2011 Jed A. Gorden, M.D.


In this article:

  • Pleural effusion occurs when fluid builds up in the space between the lung and the pleural sac.

  • It can occur with a number of conditions, including pneumonia, and may happen once or again and again.

  • A Swedish physician explains that patients have several options to relieve symptoms.

The first thing Mrs. G said when she came for the evaluation of her pleural effusion was, “I have been active all my life.” However, the simple task of bending over to tie her shoes had become impossible because she couldn't breathe. She described the build-up of fluid in her lungs — known as pleural effusion — as terrifying and robbing her of her independence.

The accumulation of pleural fluid or fluid around the lung is a common problem that can occur in a number of diseases and conditions. The most common symptom associated with pleural fluid is shortness of breath. It is our goal to rapidly manage and effectively control this problem.

As the fluid built up around Mrs. G’s lung, she described a sensation of shortness of breath and a complete inability to take a deep breath. She said she could no longer exercise, walking was taxing and the shortness of breath made it impossible for her to lay flat at night, so she was sleeping upright in a recliner. In the office, under ultrasound guidance, she had her fluid drained, improving her breathing almost immediately. We then formulated a plan to give her control over the accumulation of the fluid, giving her back more control over her life as well.

What is a pleural effusion?

The pleural space is the sac in which the lung sits. A pleural effusion is the accumulation of fluid in this sac, around the lung. One way to picture the phenomenon is when you go to the grocery store and get your groceries in a double plastic bag. The groceries are the lung and the space in between the two plastic bags is the pleural space. The fluid does not accumulate in the lung; instead, it accumulates in between the two plastic bags.

There are many causes of fluid buildup in that space, including many cancers such as breast cancer or lung cancer. Other causes include heart failure, kidney failure and pneumonia. Pleural fluid can accumulate once or re-accumulate rapidly depending on the disease and the cause.

The goals of managing a pleural effusion include making a diagnosis, relieving the shortness of breath and restoring independence and control. The three most common strategies for managing a recurrent pleural effusion include ultrasound drainage (thoracentesis), the insertion of a tunneled pleural drain for home drainage or inserting talc into the chest cavity to obliterate pleural space and stop fluid accumulation. There are pros and cons to each strategy, and it is our goal at the Center for Pleural Diseases at the Swedish Cancer Institute to find the most appropriate strategy tailored for each individual.

Mrs. G had her pleural fluid drained, and the next time it accumulated she had a tunneled pleural drain placed through a simple outpatient procedure. She now has power over her pleural fluid and drains the fluid on her schedule, which prevents it from building up and causing shortness of breath. She is back at work and playing tennis.

While the underlying disease may remain a challenge, the symptoms of shortness of breath, pain or chest tightness caused by a pleural effusion should never leave your control.

Find a doctor

If you have questions about pleural effusion, contact the Center for Pleural Diseases at Swedish. We can accommodate both in-person and virtual visits.

Whether you require an in-person visit or want to consult a doctor virtually, you have options. Swedish Virtual Care connects you face-to-face with a nurse practitioner who can review your symptoms, provide instruction and follow up as needed. If you need to find a doctor, you can use our provider directory.

Join our Patient and Family Advisory Council.

This information is not intended as a substitute for professional medical care. Always follow your health care professional's instructions.

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