What Are Pleural Effusions?
Pleural effusions are one of the symptoms that patients diagnosed with malignant pleural mesothelioma often present with.
The lungs are covered by a double layer of thin tissue called the pleura. The pleura protects and cushions the lungs. Pleural effusions are a condition that is caused by the buildup of fluid between the two layers of tissue that line the space between the chest wall and the lung. There are two layers of cells that make up the lining. The visceral lining lines the lung and the parietal layer lines the surface that interfaces with the chest wall. The pleura is made of mesothelium and connective tissue. Mesothelium is a single layer of cells that makes lubricating fluid and lines most organs inside the body. Connective tissue supports the mesothelium and supplies it with blood. Connective tissue attaches the pleura to other body parts. The space between the two layers is filled with lubricating fluid that helps the two layers to slide against each other during breathing. The fluid that lubricates the surfaces is called pleural fluid and usually it is about 10 cc of fluid total.
Pleural effusions are a common condition. In the United States, approximately 1-1.5 million new cases of pleural effusions are diagnosed each year. Of this number, approximately 150,000 are malignant pleural effusions. They are classified as malignant because there is a disturbance in the reabsorption of the fluid in the pleural space that is secondary to obstruction of the mediastinal lymph nodes draining the parietal pleura. This obstruction is usually caused by metastatic tumors from the lung, breast, ovaries and lymphomas.
Pleural effusions can present in both lungs or on one lung. Anytime that a pleural effusion is on just one side and there has been no recent infection, it can be highly suggestive of an underlying cancer.
Pleural effusions are an abnormal accumulation of fluid between the layers of tissue. Pleural effusions are classified by the analysis of the fluid that makes them up. There are two types of pleural effusions transudative and exudative. The type of effusion is determined by sending the fluid to the laboratory for analysis. The causes of the pleural effusions are different. In transudative the effusions are caused by fluid leaking into the pleural space. This type is usually due to heart failure or liver cirrhosis. Exudative effusions are caused by blocked blood vessels or lymph vessels, inflammation, pneumonia, cancer, pulmonary embolus, viral infection are the main reasons.
Malignant pleural effusions can signal that there is a cancer elsewhere in the body. It can be a complication of many types of tumors, it also, can indicate the onset of the terminal stages of cancer. Most common underlying tumors are lymphomas, and cancers of the lung, breast, and ovaries account for 75% of the cases of malignant pleural effusions. Median survival of these patients is 3 to 12 months- lung cancer patients the shortest.
Symptoms
Pleural effusions can have no symptoms or they can have some common symptoms. The common symptoms are chest pain, usually a sharp pain that is worse with cough or deep breaths, cough, fever and chills, hiccups. For malignant pleural effusions, the most common symptom is dyspnea- shortness of breath. Sometimes a medical professional can hear a friction rub on physical examination of the lungs.
The first test to determine the presence of a pleural effusion is a chest x-ray. The chest x-ray will reveal fluid around the lining of the lung, impinging on the lung’s ability to expand.
Malignant pleural mesothelioma is the medical name for cancer that starts in the mesothelium of the lungs. The National Comprehensive Cancer Network recommends that you get checked for mesothelioma if you have had more than one thoracentesis and no other attributable cause.
Pleural effusions can be treated in several different ways. The treatment is common but it is the cause that needs to be identified. A thoracentesis is a procedure where a needle is inserted under ultrasound guidance and the fluid drained out. The fluid is sent for analysis for many different tests and conditions. Thoracentesis are usually performed under ultrasound guidance. The treatment goals for a thoracentesis is to remove the fluid and then treat the cause of the fluid buildup.
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