Fluid around the lungs is one of the most common reasons for breathlessness in adults. Causes range from heart failure and infection to malignancy and tuberculosis - each needs a different treatment pathway.
What is pleural effusion?
A pleural effusion is a build-up of fluid in the space between the lung and the chest wall (pleural space). It can compress the lung and cause breathlessness. Causes include heart failure, pneumonia, tuberculosis, pulmonary embolism, kidney and liver disease, and malignancy.
Diagnosis
Assessment starts with a chest X-ray, a bedside ultrasound and a diagnostic tap (thoracentesis) to sample the fluid. If fluid keeps coming back or the cause is unclear, a VATS pleural biopsy under direct vision gives the highest diagnostic yield.
Treatment options
A simple drainage (tube thoracostomy) handles most cases. Recurrent or malignant effusions can be managed with an indwelling pleural catheter, talc pleurodesis to stick the lung to the chest wall, or a pleurectomy in selected patients.
Why see a thoracic surgeon
An effusion is a symptom, not a diagnosis. Knowing the exact cause decides treatment - and a surgeon's opinion prevents missed malignancy and repeated unnecessary taps.
