Pleural Effusion

Pleural effusion is a common complication of mesothelioma. A pleural effusion is a build up of fluid between the two layers of the pleura, the thin tissue that surrounds the lungs and chest cavity. Effusion can be uncomfortable or even painful. Treatment is usually a simple draining of the accumulated fluid. However, the space often refills which warrants more involved treatments.

With the different kinds of mesothelioma, other types of effusion may occur. These include accumulations of fluid in the abdominal cavity or around the heart. Effusion is not a harmful condition by itself. However, in the pleura it is most often associated with malignant mesothelioma or other conditions related to asbestos exposure. In addition, pleural effusion may worsen and even cause 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 one part of the mesothelium, or the thin double layer of tissue that surrounds many of the body’s organs.

Pleural effusion may be malignant or benign. The most common causes of pleural effusion are not malignant. These include heart failure, cirrhosis, pulmonary embolism, pneumonia, and kidney disease. Cancers like mesothelioma can also cause malignant pleural effusions. Whether or not a pleural effusion is a serious medical concern depends on the underlying cause.

Mesothelioma is a serious and life-threatening cause of pleural effusion. Lung cancer caused by asbestos exposure may also cause malignant pleural effusions. In addition, standard treatment for these cancers can also lead to 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.

Symptoms of Pleural Effusion

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 shortness of breath, cough, chest pain, and difficulty breathing when not standing or sitting upright. Pericardial effusion may cause similar symptoms, especially pain in the chest.

Diagnosis

Any symptoms of pleural effusion warrant a visit to the doctor. 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.

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.

A thoracentesis can 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. If there is the possibility of malignancy, your doctor may perform a biopsy to remove a tissue sample. A pathologist will then examine this sample for cancer cells.

Treatment

Treatment for malignant pleural effusion is mostly palliative. Effusion becomes more common and frequent when mesothelioma is advanced. Draining the fluid buildup will allow the patient to breathe more easily and comfortably. The simplest treatment is a thoracentesis, the same procedure used to remove fluid for testing. A thin needle draws fluid from the pleural cavity. This procedure provides temporary relief. The fluid will come back over time.

A more long-term treatment is an indwelling pleural catheter. An indwelling catheter is a small tube inserted into the pleural cavity. This tube 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 increases the risk of infection.

Another long-term solution is pleurodesis. During this procedure, a drug is inserted into the pleural cavity to close it off so fluid cannot accumulate.

Another option is to place an indwelling catheter that can be permanent so patients can drain fluid on their own at home. This can be done in both the pleural or abdominal cavity.

Surgery to remove pleural tissue will permanently stop fluid accumulation. However, this surgery is invasive. There are potential complications including excessive bleeding and infection.

Pleural effusion is an associated condition of mesothelioma and other asbestos-related illnesses. Whether the underlying cause is malignant or not, pleural effusion is often painful and difficult to live with. Fluid removal provides 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 experience any symptoms of pleural effusion, see your doctor immediately. Diagnosis is important to pinpoint the underlying cause of this condition and give more treatment options.

Page Medically Reviewed and Edited by Anne Courtney, AOCNP, DNP

Anne Courtney has a Doctor of Nursing Practice degree and is an Advanced Oncology Certified Nurse Practitioner. She has years of oncology experience working with patients with malignant mesothelioma, as well as other types of cancer. Dr. Courtney currently works at University of Texas LIVESTRONG Cancer Institutes.

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