Astonishing Facts About Pleural Effusion


America reports approximately 1.5 million cases of pleural effusion annually. Do you know what that means? It means that pleural effusion is among the top prevalent lung diseases in the US, although very little is known about it. It is a severe lung disease with a high mortality rate.

Some pleural effusion cases are associated with malignancy or cancer. One serious and life-threatening type of pleural effusion is malignant pleural effusion (MPE). Some cancer cells spread and find their way into the pleural cavity and pleural fluid to then start growing. The affected pleural fluid by the cancer cells becomes cancerous.

What is Pleural Effusion? Pleural effusion is sometimes known as "water on the lungs," and it is typically that. It is a fluid accumulation, or excess fluid buildup between two layers called pleura that cover your lungs. Pleural fluid buildup indicates an abnormality in your body caused by various conditions. Your body is then unable to balance the fluid by its formation against its resorption.

Pleural effusion is a symptom of various diseases, among them severe. Congenital heart failure is one such particular condition that has pleural effusion as one of its symptoms.

The pleural cavity that contains pleural fluid is the space between two layers that surround the lungs. One is the outer layer, which is called parietal, and it borders the thoracic cavity on one side and the lungs on the other side. The inner layer is called visceral, which covers the lungs.

Although pleural effusion may sound like a mild condition, it is contrary to that. It is a severe condition with a high mortality rate, especially the malignancy or the cancerous type. Also, some underlying diseases are life-threatening, which also contributes to pleural effusion high mortality rate.

Think about this for a moment …

One study confirmed that approximately 1.5 million people in the United States are diagnosed with pleural effusion each year.

Another research on mortality of hospitalized patients with pleural effusion was studying 104 pleural effusion patients admitted to a hospital. The results were that 15 percent of the said patients died within 30 days of their admission. And within the following 12 months, the mortality rate hiked to 32 percent. 

How Does Pleural Effusion Occur?

A pleural cavity of the two serous membranes called pleura surrounds each lung. These are the outer layer known as the parietal pleura and the inner one called the visceral pleura.

The two pleura create some liquid called pleural fluid. For a healthy person, the pleural cavity contains a minimal amount of fluid of about 10ml to 20ml. The pleura's serous membrane secretes the pleural fluid through exudation or oozing from the membrane pores. The lymphatic system reabsorbs the liquid content from the pleural cavity and into the circulation. Pleural effusion occurs when the production of the fluid in the pleural cavity and the resorption by the lymphatic system fail to balance. 

Some conditions, such as damaged blood vessels, can contribute to the excess fluid by leakage, exceeding resorption.

The pleural fluid is useful in lubricating the two pleural layers to glide smoothly without causing friction against one another during the lung's breathing process. The fluid also facilitates smooth movement by the lungs during respiration. The pleural cavity provides some vacuum through intrapleural pressure to the lungs to allow enough expansion and enough or the right shrinking without collapsing. However, the pleura can produce excess fluid due to some infections, irritations, inflammation, and other health conditions. The excess pleural fluid then accumulates in the pleural cavity, which leads to pleural effusion.

Causes of Pleural Effusion

The causing factors of pleural effusion are classified as either transudative or exudative. Before diagnosing pleural effusion, a doctor should first establish whether it is either of them, which would then narrow to the cause.

Transudative Pleural Effusion Causes

What is transudative pleural effusion?

Transudative pleural effusion is a type that leaks low-protein fluid into the pleural cavity. The common cause of transudative fluid is a non-inflammatory condition.

Some of the following health conditions cause the typical transudative pleural effusion:

  • Congestive heart failure
  • Pulmonary embolism
  • Trauma such as open-heart surgery
  • Cirrhosis
  • Protein-losing gastroenteropathy
  • Nephrotic syndrome
  • Urinothorax

Exudative Pleural Effusion. Exudative pleural effusion is a protein fluid or pus that enters the pleural cavity from lesions in lymph and blood vessels such as cuts, tumors, infection, or inflammation. Some of the typical exudate pleural effusion causes are:

  • Pneumonia
  • Tuberculosis
  • Empyema
  • Cancer
  • Systemic lupus erythematosus
  • Pancreatitis
  • Rheumatoid arthritis
  • Hemothorax (bloody fluid in the pleural cavity)
  • Asbestosis
  • Chylothorax

Pleural effusion could occur due to some less common issues which can either be transudate or exudate:

  • Pulmonary embolism (exudate or transudate)
  • Drug-induced pleural effusion from drugs such as dasatinib, methotrexate, phenytoin (exudate)
  • Esophageal rupture (exudate)
  • Post-radiotherapy (exudate)

Idiopathic Pleural Effusion. Idiopathic pleural effusion is a type with unknown origin or cause. In medical terms, it is an undiagnosed pleural effusion after exhaustive assessment.

Some pleural effusion cases, which are mostly benign types, can be elusive without showing what is causing them. For such cases, it may pose challenges to treat such an issue that has scant or no known etiology.

An idiopathic pleural effusion can continue recurring since it has no known cause and therefore limiting its treatment.

It will remain idiopathic until discoveries of new technology or procedures can meticulously diagnose it. Otherwise, idiopathic PE may continue with a conservative approach in its treatment.

Benign or Malignant Pleural Effusion. Pleural effusion can either be malignant or benign pleural effusion, depending on the causing factor. When it is malignant, it means it is a cancer type of pleural effusion, and when it is benign, it is non-cancerous.

When diagnosing and treating pleural effusion, the medical personnel must first distinguish whether the case at hand is benign or malignant.

The cause of any pleural effusion differentiates whether it is malignant or benign. The severe pleural effusion with a high mortality rate is the malignant (cancerous) type.

Malignant Pleural Effusion. Malignant pleural effusion (MPE) is a pleural effusion caused by some types of cancers. Like any other pleural effusion, this cancerous type leads to excess fluid buildup in the pleural cavity.

The malignant pleural effusion (MPE) cases approximate 150,000 annually in the US alone.

Lung cancer and breast cancer are the leading cause of malignant pleural effusion. Both lung and breast cancers take up between 50 and 65 percent of all pleural effusions caused by cancers.

Some cancerous cells metastasize to the pleural cavity and grow to cause malignant pleural effusion, creating excess pleural fluid.

Although MPE is treatable, it is a severe and life-threatening condition among other types of pleural effusion.

Benign Pleural Effusion. Benign pleural effusion has a variety of causes compared to malignant pleural effusion. It is also called non-malignant pleural effusion (NMPE), which has congestive heart failure as its leading cause.

There are varying causes of benign pleural effusion that it becomes challenging to diagnose and treat any of them.

Pleural Effusion and Mesothelioma. Pleural effusion with cases of mesothelioma disease is a common occurrence. One study carried out in 2019 on 229 mesothelioma patients resulted in 83 percent of them having pleural effusion. Pleural mesothelioma is a lung cancer type that typically affects people who have had asbestos exposure. (Read more on mesothelioma here)

In a case of pleural mesothelioma, tumor accumulation in the pleural cavity may constrict the cavity lining because of the inflammation caused by the tumor. When the lungs expand during the breathing process, they exert pressure. Also, pleural thickening inside the cavity, which is progressive tissue growth, can exert pleural cavity pressure. That pressure may extend to the blood vessels in the cavity leading to leakage and hence pleural effusion.

Pleural thickening may sometimes preside mesothelioma pleural effusion.

Pleural mesothelioma is the most common cause of pleural effusion, among other asbestos-related diseases. It slightly exceeds asbestosis, another asbestos disease.

Pleural Effusion and Pneumothorax. Both pleural effusion and pneumothorax are health conditions that affect a pleural cavity, albeit differently. As we mentioned earlier, pleural effusion is the collection of excess fluid in the pleural cavity.

On the other hand, pneumothorax is air fill-up in the pleural cavity instead of fluid. Pneumothorax is a life-threatening condition that can lead to lung collapse. The collapse of the lung can either be partial (part of the lung) or complete. Symptoms of pneumothorax are almost similar to pleural effusion. Some lung conditions or chest injuries can lead to pneumothorax.

Pleural Effusion and Pulmonary Edema. Unlike pleural effusion, which has fluid buildup in the pleural cavity, pulmonary edema has some fluid collection in the lungs air sacs or alveoli. When fluid collects in the alveoli or air sacs of the lungs, it causes breathing difficulty. 

Congestive heart failure is one of the top causes of pulmonary edema. A weak heart fails to pump blood efficiently, backing some fluid in the blood vessels, which serve the lungs. With time, fluid fills up in the alveoli causing pulmonary edema.

Pleural effusion and pulmonary edema share most symptoms except for the productive cough. While pleural effusion produces mucus-like phlegm, pulmonary edema produces bloody froth.

Symptomatic and Asymptomatic Pleural Effusion. Pleural effusion is a typical symptomatic disease. However, some rare cases would go unnoticed for lack of symptoms or signs, a type called asymptomatic pleural effusion.

The asymptomatic pleural effusion can have a late diagnosis, if any at all, for lack of signs or symptoms. If it is the case, you may not know that you have pleural effusion until your doctor accidentally stumbles upon it. A doctor can find asymptomatic pleural effusion while on a physical test for another disease or routine checkup.

Some of the leading causes of asymptomatic pleural effusion (APE) are malignancy, benign asbestos, pneumonia, congestive heart failure, thoracic surgery, and abdominal surgery. For instance, we can single out benign asbestos pleural effusion (BAPE) and malignant pleural effusion (MPE) primarily caused by mesothelioma. The two conditions can take many years from the time of exposure to reveal symptoms. During the symptomless benign asbestos and mesothelioma period, the conditions can progress to cause pleural effusion without symptoms as well.

It is unclear how long the asymptomatic pleural effusion cases take before becoming symptomatic or whether they remain that way. What is clear is that close observation can successfully manage asymptomatic pleural effusion.

Persistant hiccupping, shortness of breath and fever are some symptoms of pleural effusion.

Pleural Effusion Symptoms

Pleural effusion has a variety of causing factors. Therefore, the symptoms can also vary with each case, depending on the factor causing it.

The following are some of the common pleural effusion symptoms:

  • Dry (non-productive) cough
  • Dyspnea (shortness of breath)
  • Difficulty breathing and taking deep breaths
  • Chest pain
  • Fever
  • Orthopnea (inability to breathe when lying down)
  • Hiccupping persistently

Preventing Pleural Effusion

Pleural effusion is one of the symptoms of many health conditions, some chronic while others are life-threatening. It would, therefore, be more challenging to prevent pleural effusion without first treating the underlying conditions.

For instance, if the underlying condition is tuberculosis, then you would first have to prevent the TB and hence prevent pleural effusion.

However, you can avoid some of the pleural effusion risk factors which can exacerbate the condition. You can do the following:

  • If you smoke, please stop.
  • You can stop or reduce alcohol consumption.
  • Watch your diet, and avoid unhealthy eating habits.
  • Seek early treatment for any disease, especially those that lead to pleural effusion

Pleural Effusion Complications

As much as pleural effusion is a severe disease, it can lead to other more severe complications, which may also be life-threatening. Some of these are:

  • Partial (atelectasis) or complete (pneumothorax) lung collapse
  • Pulmonary edema
  • Lung scarring
  • Sepsis (infection of the blood)

Pleural Effusion Treatment

Treatment of pleural effusion is complex and involves various procedures, and each case would have a different therapy depending on its cause and severity.

The following are some of the standard pleural effusion treatment procedures:

Treating Pleural Effusion Underlying Cause

As we had mentioned, pleural effusion is a symptom of various health conditions. It would be best to treat the underlying cause first, which would be the initial therapy for pleural effusion.

For instance, pleural effusion caused by tuberculosis would consider short-course TB treatment. Pleural effusion caused by connective tissue disease such as rheumatoid arthritis would require steroids for its treatment.

Malignant pleural effusion would require chemotherapy, radiotherapy, or surgery if need be.

Other Treatment Procedures

Thoracocentesis: Thoracocentesis is a draining therapy for excess pleural fluid. Your doctor inserts an injecting needle to penetrate the chest cavity to suction the intended fluid for drainage.

It is also a therapy for empyema alongside some antibiotics.

Pleurodesis: Pleurodesis is a procedure used for pleural effusion that keeps on refilling with excess fluid. It is drug therapy. The drug helps the two pleural tissues adhere together by adding some pleurodesis irritant drug to prevent more fluid collection.

Surgical therapy: Pleural effusion caused by various cancers such as lung cancer, breast cancer, and mesothelioma would require surgery besides chemotherapy or radiotherapy.

Diagnostic chest X-ray film of a patient with pulmonary edema

​Diagnosing Pleural Effusion

A thorough pleural effusion diagnosis precedes the proper management and treatment. There are different procedures of pleural effusion diagnosis your doctor may use while diagnosing your case, again depending on your causing factor. Some of the pleural effusion diagnosis procedures are:

Medical History. Your doctor may put through some questions to establish your symptoms and your health condition. It is essential to specify everything you find abnormal that is happening to you. Your doctor may also want to know about your respiratory infection or any other disease that might have occurred lately.

Physical Examination. A physical examination using a stethoscope is what may follow questioning. Your doctor may use the stethoscope to listen to your lungs for the familiar sounds when inhaling and exhaling. Some of the pleural effusion signs your lungs may reveal are lack of breathing sounds, decreased vibration from low-frequency vocalization, and percussion dullness.

Chest X-ray. Your doctor might need to perform a chest x-ray for images to clarify the extent of pleural effusion. The x-ray pictures help diagnose the condition further.

CT-Scan (Computed Tomography Scan). CT-scan is another imaging diagnosis process. It is a more sensitive process than an x-ray in detecting pleural effusion.

Thoracentesis. Your doctor might go a step higher in diagnosing pleural effusion by performing thoracentesis. Thoracentesis is an invasive process of removing some fluid from the pleural space using a thin needle. Thoracentesis is a diagnostic process as well as therapeutic when draining the excess fluid.

Pleural Biopsy. Your doctor may use pleural biopsy for critical diagnosis and a higher diagnosis level when other procedures fail to conclude the results. It is a helpful process, especially when suspecting malignancy in the pleural cavity. To perform a pleural biopsy, your doctor would need to remove a pleural tissue sample by using a needle inserted through the chest cavity and the pleura.

Thoracoscopy Surgery. Thoracoscopy for pleural effusion is an intricate diagnosis procedure useful in identifying the type of pleural effusion and what causes it. It is a minimally invasive surgery with a video assistance technique. During the video-assisted thoracoscopic surgery (VATS), your doctor inserts a thoracoscope into your chest, which transmits video images when performing surgery. The procedure can also be useful when removing some pleural fluid for lab analysis to identify what is causing the pleural effusion case at hand. This medical instrument can also be used as a therapy to drain excess fluid from the pleural space.

Alternative Natural Treatment for Pleural Effusion

Treating pleural effusion with natural remedies would first require identifying and dealing with the underlying disease causing the condition. For instance, if congenital heart failure causes pleural effusion, you need to treat the heart condition to deal with pleural effusion.

There are varieties of natural treatment for each underlying condition in pleural effusion. Therefore, your natural health practitioner would need to find out the underlying disease before prescribing any therapy.

A natural health practitioner with a broad knowledge of traditional herbs and supplements treatment would be the right person to approach for your natural remedy.

At Island Healthworks Natural Clinic, we take pride in having a vast experience of more than thirty-five years while dealing with many different illnesses.

Our primary concern is to restore your health by using high-quality organic herbs and supplements from trusted sources.

If you need more information on pleural effusion natural treatment, you can call us using our telephone number 250-468-7685 or write an email using our email address: This email address is being protected from spambots. You need JavaScript enabled to view it..

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You breath is your health. Please take care of your lungs.

Yvonne Dollard Perc: Owner of Island Healthworks, Natural Health Practitioner, Teacher, Writer and Editor.
Elizabeth Njuguna: Researcher, Freelance Writer, with a Focus on Natural Health.
Sherry Robb: Print, Web and Social Media Designer Specializing in the Natural Health and Fitness Industries.

Island Healthworks offers in-person and virtual consultations for assessment of your specific needs, with health & lifestyle coaching, featuring the best of integrative natural health care. To book your consultation, please call 250-468-7685!

This article is intended for educational purposes and the information contained within is not intended to treat, diagnose or cure any disease or health problem. Please seek appropriate medical attention for any health complaints. We cannot take responsibility for your health care decisions. Our intent is only to offer health information to help you with your search for better health. 

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Saturday, 08 May 2021