Pleural Effusion

Pleural effusions are one of the most serious and painful symptoms that develop in pleural mesothelioma patients. Effusions are a buildup of fluid within the lung lining (the pleura) as the result of inflammation caused by a cancerous tumor. It’s important for patients to receive treatment for pleural effusions to avoid complications such as a collapsed lung.

Written and Fact-Checked by: Laura Wright

What Are Pleural Effusions?

A pleural effusion is a buildup of fluid between the lining of the lungs and the chest cavity. Effusions are a symptom commonly associated with lung cancers.

Doctor showing X-rays of lungs to patient

Over 1.5 million people are diagnosed with pleural effusions each year in the United States. Pleural effusions are a common symptom that develops in over 90% of pleural mesothelioma patients.

As fluid builds up in between the pleural linings, it restricts lung movement. Pleural effusions are one of the main causes of pleural mesothelioma symptoms like shortness of breath and tightness in the chest.

Pleural effusions, or “water on the lungs”, can be treated with palliative (pain-relieving) surgeries that drain fluid from the chest. Draining excess fluid buildup relieves chest pressure, allowing the patient to breathe more easily.

Research has shown that virtually every patient with pleural effusions who underwent fluid drainage experienced a decrease in symptoms.

Learn how mesothelioma and pleural effusions are diagnosed and treated in our Free Mesothelioma Guide.

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Pleural Effusion Causes

Pleural effusions are caused by an excess buildup of fluid in the pleura, the protective lining that covers the lungs and chest.

In a healthy person, there is always a small amount of fluid in the pleura which allows for lubrication and movement. The normal amount of pleural fluid allows you to breathe comfortably. The body is good at regulating this fluid and will evacuate excess fluid on its own.

In patients who develop pleural mesothelioma, tumors accumulate in the pleura, which causes inflammation and constriction of the lining. Added pressure due to inflammation causes pleural blood vessels to leak fluid, which leads to an excess of liquid in the pleura.

Pleural effusions are common in pleural mesothelioma patients. However, other asbestos-related illnesses can cause pleural effusions as well.

Lung cancers and asbestosis caused by asbestos exposure can also create pleural effusions.

Pleural Effusion Symptoms

Specialists consider pleural effusions to be a strong early indicator of pleural mesothelioma. In fact, effusions are responsible for many mesothelioma symptoms.

Signs and symptoms of pleural effusions include:

  • Chest pain
  • Dry cough
  • Fatigue
  • Fever
  • General feeling of being unwell (malaise)
  • Not being able to breathe properly when lying down
  • Quickened breathing
  • Sharp pain when coughing or taking deep breaths
  • Shortness of breath

As pleural effusions worsen, the shortness of breath may cause panic in the affected person. Some people report feeling as though they are being suffocated because the constriction has become so intense. Other people report feeling like they are drowning as the fluid accumulates.

Man coughing

Additional complications from pleural effusions can include infections. Empyema — when pleural fluid becomes infected — can be fatal, especially in patients with advanced cancer. If mesothelioma spreads to the lymphatic system, it will compromise the immune system and make it difficult to combat infection. Untreated effusions can also cause a lung to collapse.

Some patients may have pleural effusions and never display any symptoms, making it a difficult condition to detect. Those with pleural mesothelioma may not feel the symptoms of pleural effusions until the cancer is in advanced stages.

That said, quickly reporting pleural effusion symptoms and any history of asbestos exposure could lead to a life-saving diagnosis of pleural mesothelioma.

Testing for Pleural Effusions

If you’re experiencing pleural effusion symptoms, then it’s important to know the underlying cause so that you can receive proper treatment.

If you report symptoms such as difficulty breathing and chest pain to your doctor, they will likely order a chest X-ray.

Chest X-rays can show doctors whether or not there is a concerning level of fluid buildup in the chest. However, fluid buildup can also indicate other conditions like pneumonia or congestive heart failure. So, it’s vital to report any known history of asbestos exposure to your doctor.

If X-rays confirm there is excess fluid, the next step is to take a sample of the fluid for testing. Doctors use a procedure called a thoracentesis, where a needle or thin tube is inserted into the space where the fluid has accumulated. A sample of the fluid is taken and sent to a medical lab for testing to determine if you have mesothelioma.

Lab technicians analyze the fluid to determine if the effusion has been caused by cancer. Protein-rich pleural fluid is a strong indicator of cancer, and in these cases, further diagnostic steps must be taken to determine if the cause is mesothelioma or another type of cancer such as lung cancer, breast cancer, or lymphoma.

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Pleural Effusion Treatments

Treating pleural effusions is an important part of an overall mesothelioma treatment plan.

While addressing pleural effusions will not stop or control the mesothelioma itself, managing this symptom will help make the patient comfortable and improve their quality of life. In other words, treating pleural effusions is part of palliative care.

When doctors treat pleural effusions, they use the thoracentesis technique to drain out the excess fluid. A needle is inserted directly into the chest to collect fluid and drain it into a bag. Thoracentesis is a simple and quick procedure done with local anesthetic. However, patients will often experience a continued recurrence of pleural effusions.

Rather than having to keep undergoing fluid drainage, doctors may recommend pleurodesis. During pleurodesis, doctors administer certain types of drugs into the pleura to cause it to become inflamed.

These drugs are known as sclerosing agents, and they include substances like talc, tetracycline, or doxycycline. These agents deliberately cause scarring and inflammation in the pleural tissues (pleura sclerosis) to close up the pleura and prevent fluid accumulation. However, this is only a short-term solution. Doctors only perform it in certain cases when the patient is healthy enough.

Getting Personalized Treatment for Pleural Mesothelioma

Ultimately, doctors always remain focused on treating the underlying cause of pleural effusions, which is often pleural mesothelioma. If they can effectively treat mesothelioma using a combination of surgery, chemotherapy, and radiation, then they can also manage symptoms like pleural effusions.

If you suspect you may have pleural mesothelioma due to signs of effusions, contact a mesothelioma specialist today.

These specialists are surgical oncologists dedicated to researching and treating malignant mesothelioma and can provide life-extending therapies to many patients.

For more information on working with a mesothelioma specialist, contact our Patient Advocates now.

Malignant Pleural Effusion FAQs

How long can you live with a pleural effusion?

It depends. Pleural effusions may be caused by a variety of different medical conditions, and your prognosis is determined by what condition you may have.

For example, a pleural effusion caused by an infection may be cleared up with antibiotics. However, pleural effusions caused by cancer may result in a poor prognosis.

Your doctor can help you to determine the underlying cause of your pleural effusion through testing.

What are the causes of pleural effusions?

There are a few different medical conditions that can cause pleural effusions.

Common causes include:

  • Cancer: Pleural effusions may be a sign of cancer, such as mesothelioma, lung cancer, or lymphoma.
  • Heart failure: If the heart is not pumping effectively, fluid may build up in the lungs and cause a pleural effusion.
  • Lung infections: Pneumonia, tuberculosis, and other lung infections may lead to pleural effusions.
  • Other medical conditions: Trauma to the chest, certain medications, and other medical conditions may cause pleural effusions.

If you are experiencing symptoms of a pleural effusion, it is important to talk to your doctor immediately. Pleural effusions may be caused by serious, life-threatening illnesses that need to be treated promptly.

Does mesothelioma cause pleural effusionsa?

Yes, sometimes. Pleural mesothelioma, which affects the lining of the lungs and is the most common type of mesothelioma, can result in a pleural effusion.

In patients with pleural mesothelioma, tumors may accumulate in the pleura and cause inflammation and constriction of the lining.

Added pressure due to inflammation causes pleural blood vessels to leak fluid, which leads to an excess of liquid in the pleura.

How many times can you drain a pleural effusion?

Pleural effusions can be drained multiple times a week, or even daily in extreme cases. A physician will recommend how often effusions should be drained.

Unfortunately, draining a pleural effusion is a temporary solution. Doctors will need to treat the underlying cause of the pleural effusion in order to prevent fluid from building up within the pleura.

Written by:

Lead Editor

Laura Wright is a journalist and content strategist with more than 14 years of professional experience. She attended college at the University of Florida, graduating magna cum laude with a bachelor’s degree in journalism in 2008. Her writing has been featured in The Gainesville Sun and other regional publications throughout Florida.

3 References
  1. Kamran Boka, MD, MS, “Pleural Effusions” Retrieved from Medscape. Accessed on December 27, 2022.

  2. Winston W Tan, MD, FACP, “Mesothelioma: Practice Essentials” Retrieved from Medscape. Accessed on December 27, 2022.

  3. Cleveland Clinic, “Pleural Effusion Causes, Signs & Treatment” Retrieved from: https://my.clevelandclinic.org/health/diseases/17373-pleural-effusion-causes-signs–treatment. Accessed on December 27, 2022.

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