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Pleural Effusion

Also sometimes known as “water on the lungs,” pleural effusion is just one of several symptoms that often plague individuals who have developed malignant pleural mesothelioma. With pleural effusion, fluid accumulates between the layers of the pleura, the area outside the lungs that is designed to protect the organ. The National Cancer Institute estimates that about 200,000 cases of malignant pleural effusion are diagnosed each year and notes it is quite common to observe this problem in those with pleural mesothelioma, especially when the disease has reached an advanced stage.

Pleural Effusion Symptoms in Pleural Mesothelioma

Pleural effusion is truly one of the most uncomfortable and debilitating symptoms of pleural mesothelioma. When the fluid accumulates in the pleural space, it causes several symptoms that can greatly impact the patient’s quality of life and make them feel constantly fatigued. These include difficulty breathing, chest pain and dry mouth. Often, those with pleural effusion may need oxygen to help breathe and breathing is particularly difficult when the person is lying down.

Diagnosis

When pleural effusion is suspected, especially in a patient already diagnosed with pleural mesothelioma, the doctor – often a pulmonologist – will probably order some tests to confirm the presence of fluid in the chest area. Often, a simple chest x-ray will do the job, especially if the amount of fluid accumulated is about 300 milliliters or more. Sometimes a CT scan is necessary or an ultrasound may be suggested.

The doctor will also check for other signs of this problem, which sometimes mimics pneumonia. These include decreased vocal resonance and diminished breath sounds and chest movement on the affected side of the body. If pleural effusion is indeed discovered, some fluid may be removed from the pleural space for testing in order to determine if cancer cells are present. 

If these non-invasive tests are not successful in discerning a diagnosis, the doctor may order a thoracoscopy, a minimally-invasive, video-assisted surgical procedure that takes a close look at the pleural area. If this procedure is performed, treatment can usually be administered at the same time.

Treatment with Pleural Mesothelioma

Because pleural effusion is very uncomfortable and often restricts the patient’s activities, treatment to remove the fluid is recommended shortly after diagnosis of the problem. Most often, the fluid is removed by means of a simple surgical procedure known as thoracentesis. This procedure, which can be performed in a doctor’s office under a local anesthesia, involves the insertion of a thin needle into the pleural space, which drains the fluid by means of a vacuum bottle. In pleural mesothelioma patients the procedure may have to be repeated again and again if fluid retention continues. The fluid can also be drained through a chest tube in a procedure called a tube thoracostomy.

For recurring cases of pleural effusion, a surgical procedure known as pleurodesis may also be suggested. During this surgery, the doctor introduces a talc substance into the area between the pleural layers. It irritates the pleura and closes off the space between the layers, preventing further effusion. This is generally performed in the hospital operating room under general anesthesia and requires a week or two of at-home recovery in many cases.

Sources:

1. http://www.nlm.nih.gov/medlineplus/ency/article/000086.htm
2. http://emedicine.medscape.com/article/299959-overview
3. http://emedicine.medscape.com/article/807375-overview
4. http://my.clevelandclinic.org/disorders/pleural_effusion/ts_overview.aspx