Pleural effusion is a build-up of fluid between the two layers of the pleura, the thin tissue surrounding the lungs and chest cavity.[1] Pleural effusion is a common symptom and complication of pleural mesothelioma and is uncomfortable or even painful. Treatment involves draining the fluid, but more permanent procedures may be required if it continues to accumulate.
About Pleural Effusion
Effusion refers to an unnatural buildup of fluid. Pleural effusion is fluid buildup in the pleural cavity around the lungs. The fluid collects between the two layers of the pleura, the visceral (inner) and parietal (outer) layers.
Nearly 1.5 million people in the U.S. are diagnosed with pleural effusion every year.[2] Causes range from infections to heart failure to cancer.
Transudative pleural effusion occurs when pressure on organs and their blood vessels causes them to leak fluid into the pleural space. Exudative pleural effusion results from infections, inflammation, or tumors. Mesothelioma causes exudative pleural effusion.
Fluid in the lungs is uncomfortable. It can be painful and restrict breathing. In some cases, it causes mild or no symptoms. The severity often depends on the underlying cause.
What Causes Pleural Effusion?
Pleural effusion may be malignant or benign. The most common causes of pleural effusion are not malignant:
- Congestive heart failure
- Cirrhosis
- Pulmonary embolism
- Pneumonia
- Kidney disease
Malignancy, cancers like mesothelioma, can also cause malignant pleural effusions.[3] Whether or not a pleural effusion is a serious medical concern depends on the underlying cause.
Mesothelioma is a rare cancer, but pleural effusion is a common complication. It occurs in 90 percent of mesothelioma patients.[4] Lung cancer caused by asbestos exposure may also cause malignant pleural effusions.
The standard treatment for mesothelioma and lung cancer can also cause effusion. Peritoneal mesothelioma (cancer of the abdominal mesothelium) and pericardial mesothelioma (cancer of the mesothelium surrounding the heart) may also cause effusions in those areas.
How Are Asbestos and Mesothelioma Related to Pleural Effusion?
There are many potential causes of pleural effusion, but it is a common complication of mesothelioma caused by asbestos exposure.
Asbestos fibers in the airways trigger inflammation, which can cause both cancer and fluid accumulation. Asbestos might cause effusion without ever progressing to cancer. For patients with mesothelioma, effusion is an earlier sign that occurs less often as the cancer progresses.
How Serious Is Pleural Effusion?
Pleural effusion is serious because it indicates an underlying condition. By itself, fluid around the lungs is uncomfortable but manageable.
The underlying cause of pleural effusion could be a serious illness like mesothelioma or congestive heart failure. Diagnosis of pleural effusion should lead to more diagnostic tests to find the cause.
Pleural Effusion Symptoms
Pleural effusion is much more common than pericardial or peritoneal effusion. This is mainly because pleural mesothelioma is the most common form of this rare cancer. Symptoms of pleural effusion include:[3]
- Shortness of breath
- Cough
- Chest pain
- Difficulty breathing when not standing or sitting upright
Pericardial effusion may cause similar symptoms, especially pain in the chest.
Diagnosing Pleural Effusion
If the cause of this fluid buildup is related to asbestos exposure, the likely cause is malignant mesothelioma. If you have been diagnosed with mesothelioma and experience any of these uncomfortable symptoms, you may have a pleural effusion.
This condition is more likely to develop as your asbestos-related condition progresses. Any symptoms of pleural effusion warrant a visit to the doctor.
If you have been diagnosed with mesothelioma, a chest X-ray may be enough for your doctor to detect fluid in the pleural cavity. X-rays are a simple way to diagnose pleural effusion; however, if you have not been diagnosed with mesothelioma, your doctor will need to find the underlying cause of the effusion.
If this is the case, you may need more advanced imaging tests, like an MRI or CT scan. These more detailed images allow your doctor to detect abnormal tissue or tumors in your chest cavity.
Doctors may use a thoracentesis to remove fluid for further examination. A thin needle or tube is inserted into the pleural cavity to draw fluid that has accumulated there. The fluid is then examined. Pleural fluid analysis in mesothelioma doesn’t provide a definite diagnosis, but it can lead to further examination.
If malignancy is suspected, your doctor may perform a biopsy to remove a tissue sample. A pathologist will then examine this sample for cancer cells.
Will Pleural Effusion Go Away on its Own?
A minor buildup of fluid can go away with time, especially if caused by an infection or inflammation that resolves on its own.
Chronic conditions that cause more extensive effusions will continue to trigger fluid buildup. For someone with mesothelioma, for instance, the effusion is unlikely to go away without intervention. It must be managed with treatments.
What Are the Treatment Options for Pleural Effusion?
The treatment goals for pleural effusion are to drain fluid in the lungs and make the patient more comfortable.[5]
Effusion becomes more common and frequent when mesothelioma is advanced. Draining the fluid buildup will allow the patient to breathe more easily and comfortably.
Several possible treatments for pleural effusion exist. The choice depends on the severity of symptoms and the patient’s overall health and preferences.
Thoracentesis
The simplest treatment is thoracentesis, which is the same procedure doctors use to remove fluid for diagnostics. A thin needle draws fluid from the pleural cavity. This procedure provides temporary relief. The fluid will come back over time.
Indwelling Catheter
An indwelling pleural catheter, a small tube inserted into the pleural cavity, is a more long-term treatment. The catheter remains in place to continuously drain fluid.
The tube connects the cavity to the outside of the body. Although it provides constant relief from pleural effusion, it also carries the risk of infection at the catheter site.[5]
Another option is to place a permanent indwelling catheter in the pleural or abdominal cavities so patients can drain fluid at home.
Pleurodesis
Another long-term solution is pleurodesis, a procedure that closes the gap between the layers of the pleura to prevent fluid buildup from recurring.
To perform a pleurodesis, doctors insert a tube into the pleural space. They use the tube to inject a drug that seals the pleural space. If a patient is undergoing another procedure, the doctors can perform the pleurodesis at the same time while the patient is under anesthesia.[5]
Pleurectomy
Pleurectomy is a surgical procedure that removes some or all of the pleura. Surgery to remove pleural tissue will permanently stop fluid accumulation; however, this surgery is invasive. There are potential complications, including excessive bleeding and infection.
Can I Get Compensation for Asbestos Pleural Effusion?
Pleural effusion and some of its underlying causes are asbestos-related pleural diseases. This means you can seek compensation if you were exposed to asbestos on the job or during military service.
If you worked for a company that used asbestos, you might be able to sue the company or the asbestos supplier for damages. If the company filed for bankruptcy, there may be an asbestos trust. A lawyer can help you take the next step and file a lawsuit or claim.
If you encountered asbestos during military service, the Veterans Administration offers benefits. Pleural effusion is a recognized asbestos illness. You can file a claim for disability and other benefits if you can prove you were exposed to asbestos while on duty.
If the effusion is caused by mesothelioma, treatment is primarily palliative but still important. If you have been exposed to asbestos and experience any symptoms of pleural effusion, see your doctor immediately. Diagnosis is essential to pinpoint the underlying cause of this condition and give more treatment options.
