SECTION Lung and Airway Disorders

SUBJECT Pleural Disorders

Pleural Effusion

Pleural effusion is the abnormal accumulation of fluid in the pleural space.

• Fluid can accumulate in the pleural space as a result of a large number of disorders, including infections, injuries, heart or liver failure,
blood clots in the lung blood vessels (pulmonary emboli), and drugs.

• Symptoms may include difficulty breathing and chest pain, particularly when breathing and coughing.

• Diagnosis is by chest x-rays, laboratory testing of the fluid, and often CT scan.

• Large amounts of fluid are drained with a tube inserted into the chest.

Normally, only a thin layer of fluid separates the two layers of the pleura. An excessive amount of fluid may accumulate for many reasons,

including heart failure, cirrhosis, pneumonia, and cancer.

Types of Fluid: Depending on the cause, the fluid may be either rich in protein (exudate) or watery (transudate). Doctors use this

distinction to help determine the cause.

Blood in the pleural space (hemothorax) usually results from a chest injury. Rarely, a blood vessel ruptures into the pleural space when no

injury has occurred, or a bulging area in the aorta (aortic aneurysm) leaks blood into the pleural space.

Pus in the pleural space (empyema) can accumulate when pneumonia or a lung abscess spreads into the space. Empyema may also

complicate an infection from chest wounds, chest surgery, rupture of the esophagus, or an abscess in the abdomen.

Lymphatic (milky) fluid in the pleural space (chylothorax) is caused by an injury to the main lymphatic duct in the chest (thoracic duct) or by

a blockage of the duct by a tumor.

Fluid in the pleural space that contains excessive amounts of cholesterol results from a long-standing pleural effusion caused by a

condition such as tuberculosis or rheumatoid arthritis.

Common Causes of Pleural

Effusion*
• Heart failure
• Tumors