Pleural Effusion

Pleural effusion is a common complication and related condition associated with asbestos exposure and mesothelioma. It occurs when fluid accumulates between the two layers of the pleura, the thin tissue that surrounds the lungs and chest cavity. This effusion can be painful and uncomfortable. Treating it can be as simple as draining the fluid, but the space often refills warranting more involved treatments.

Other types of effusions may occur with the different kinds of mesothelioma, including a buildup of fluid in the abdominal cavity or around the heart. Effusion is not a harmful condition by itself, but in the pleura it is most often associated with malignant mesothelioma or other conditions related to asbestos exposure. Pleural effusion may even worsen such conditions, including pleural thickening. Diagnosis and treatment of pleural effusion is important for a patient’s comfort and overall wellness.

Pleural Effusion: Malignant and Non-Malignant

Effusion refers to an unnatural buildup of fluid. Pleural effusion occurs in the pleural cavity, between the two layers of the pleura. The pleura is just one part of the mesothelium, the thin, double layer of tissue that envelops many of the organs in the body. The pleura are in the chest cavity and when fluid builds up between these two layers, it is called a pleural effusion.

Pleural effusion may be malignant—related to cancer—or non-malignant. Many of the most common causes of pleural effusion are not malignant: heart failure, cirrhosis, pulmonary embolism, pneumonia, and kidney disease. Cancers, like mesothelioma, cause malignant pleural effusions. Whether or not a pleural effusion is a serious medical concern depends on the underlying cause.

Mesothelioma is a serious, malignant, and life-threatening cause of pleural effusion. Lung cancer caused by asbestos exposure may also cause malignant pleural effusions. Treatment for these cancers can also cause an effusion. Peritoneal and pericardial mesothelioma—cancer in the mesothelium of the abdomen or heart—may also cause effusions in those areas.

Symptoms of Pleural Effusion

Pleural effusion is much more common than pericardial or peritoneal effusion because pleural mesothelioma is the most common type of this cancer. Symptoms of pleural effusion include shortness of breath, a cough, a pain in the chest, especially when breathing in, and difficulty breathing when not standing or sitting upright. Pericardial effusion may cause similar symptoms, especially pain in the chest. Peritoneal effusion causes swelling and discomfort in the abdomen and a feeling of fullness.

Diagnosis

Any symptoms of pleura effusion warrant a trip to the doctor for a diagnosis. The fluid buildup is caused by some other condition and if it is related to asbestos, the cause is likely malignant mesothelioma. If you have already received a diagnosis of mesothelioma and you begin to feel uncomfortable symptoms, you may have developed a pleural effusion that needs to be diagnosed and treated. You are more likely to develop it as your asbestos-related condition progresses and gets worse.

If you have already been diagnosed with mesothelioma, a chest X-ray may be enough for your doctor to see that you have fluid in the pleural cavity. This is 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. You may need more advanced imaging tests, like an MRI or CT scan so your doctor can look for abnormal tissue or tumors in your chest cavity.

You may also have some of the fluid removed for examination through a simple procedure called a thoracentesis. A thin needle or tube will be inserted into the pleural cavity to withdraw some of the fluid that has built up there. Upon investigation of the fluid, if it seems possible it is caused by a malignancy, your doctor may perform a biopsy to remove a small sample of tissue. This is then sent to a pathologist to be examined for cancer cells.

Treatment

Treatment for malignant pleural effusion is mostly palliative. Effusion becomes more common and frequent when mesothelioma is advanced and the cancer cannot be cured. Removing the fluid helps the patient to feel more comfortable and to breathe with less pain. The simplest treatment is a thoracentesis, the same procedure used to remove fluid for testing. A thin needle is inserted and withdraws all the fluid from the pleural cavity. This usually relieves symptoms for a short period of time, but the fluid will come back.

A longer-term treatment involves installing an indwelling pleural catheter. This is a small tube that is left in place to continuously drain fluid from the pleural cavity. The tube connects the cavity to the outside of the body, and although it provides constant relief from pleural effusion, it may also put the patient at risk for infections. Another longer-term solution is a pleurodesis. This procedure actually closes off the pleural cavity by the insertion of a drug, so that fluid cannot collect there.

The most involved procedure for treating pleural effusion is to surgically install a shunt. This is a tube that carries the extra fluid from the pleural cavity down into the abdominal cavity. There the fluid is easier to drain and remove from the body. A surgery to remove part of the pleural tissue may also be done to permanently stop fluid from building up. Surgery is invasive and comes with risks, such as excessive bleeding and infections, but it may be work the risks to bring relief.

Pleural effusion is a common associated condition of mesothelioma and other asbestos-related illnesses. Whether the underlying cause is malignant or not, pleural effusion is uncomfortable and painful. To remove the fluid provides a patient with a better quality of life and the chance to regain some level of activity. If the effusion is caused by mesothelioma, treatment is largely palliative, but still important. If you have been exposed to asbestos and you experience any symptoms of pleura effusion, see your doctor right away. The sooner it is diagnosed and the underlying cause is found, the more treatment options you will have and the more effective they will be.