Pleural effusion is a build-up of excess fluid between the pleura layers outside the lungs. The pleura are membranes lining the lungs and the chest cavity. They provide lubrication, so breathing is easier. In healthy people, a small amount of fluid is contained in the pleura. (My.Clevelandclinic.org). Pleural effusions have many causes, but one is asbestos exposure which can lead to mesothelioma.
Mesothelioma is rare, but if you were exposed to asbestos, you do have a risk of developing the disease, as well as pleural effusions. That is why it is vital to disclose any instances of asbestos exposure in your work or personal history to your doctor. Your physician can then monitor you for any signs of asbestos-related conditions, which may develop years after the asbestos exposure.
Below is more information about malignant pleural effusions and the condition is related to asbestos exposure.
Causes of Malignant Pleural Effusions
Pleural effusion is common, with 100,000 cases diagnosed in the US annually. (Cancer.gov). Depending on the cause, fluid build-up around the lungs can be protein-rich (exudative) or protein-poor (transudative). These categories help doctors to determine what is causing the pleural effusion.
Protein-rich pleural effusions are caused by:
- Asbestos exposure and mesothelioma
- Other types of cancer
- Pneumonia
- Pulmonary embolism
- Kidney disease
- Inflammatory disease
If the pleural effusion is malignant, the cause is cancer, which can include mesothelioma. While asbestos exposure can cause malignant pleural effusions, other types of cancer can, too.
Protein-poor pleural effusions are caused by:
- Heart failure
- Cirrhosis
- Post open heart surgery
- Pulmonary embolism
Below are less common causes of pleural effusions:
- Tuberculosis
- Autoimmune disease
- Bleeding from chest trauma
- Uncommon chest and abdominal infections
Pleural effusions can be complicated and uncomplicated. Uncomplicated pleural effusions contain fluid that has no signs of inflammation or infection. This type of pleural effusion is less likely to cause long-term lung problems. But complicated pleural effusions have fluid with inflammation and infection involved. This type of disorder requires treatment immediately, which can include chest drainage.
Symptoms of Malignant Pleural Effusions
Some patients with fluid build-up around the lungs do not have symptoms. Only when your doctor performs an X-ray for another reason is the pleural effusion discovered. You could have unrelated symptoms because of the disease that caused the condition. Common symptoms of pleural effusion are: (Cancer.net)
- Chest pain
- Dry cough
- Shortness of breath
- Inability to breath easily (orthopnea)
How Malignant Pleural Effusions Is Diagnosed
Your healthcare provider will talk to you about your pleural effusion symptoms and perform a physical examination. First, the doctor will tap on the chest and listen with his stethoscope. (WebMD.com). If he finds anything unusual, he will order various imaging tests, such as:
- Chest X-ray: Pleural effusions show as white spots on an X-ray, while air spaces look black. If you have pleural effusions are likely, your doctor could have more X-rays taken as you lie on your side. Side X-rays will show if the fluid flows easily in the pleural space.
- Computed tomography (CT scan): This imaging test takes many X-rays quickly. A computer builds a detailed image of the whole chest both inside and outside. A CT scan shows far more detail than a single X-ray.
- Ultrasound: A probe on the chest builds images of the body’s interior. The images show on a video screen. Your physician may use ultrasound to see where the fluid is so a sample can be obtained for further analysis. Your doctor could also do a thoracentesis. This procedure takes a small amount of the fluid out for testing. This is done by inserting a small needle and tube between the ribs into the pleural space.
Some doctors may also perform a pleural biopsy. This procedure involves removing a small amount of tissue from your pleura. This can be accomplished by inserting a needle into your chest cavity. If your physician confirms a pleural effusion but cannot determine the type, he may order a thoracoscopy. This procedure allows the doctor to see inside your chest cavity with a fiber-optic camera. (Healthline.com)
Treatment for Malignant Pleural Effusions
If the pleural effusions are malignant, the underlying cause may be mesothelioma or another type of cancer. Mesothelioma is notoriously difficult to treat, and the prognosis is generally poor. However, the earlier the asbestos cancer is detected, the better your treatment options.
Your doctor may provide the following treatments for your pleural effusions. While these methods do not cure cancer, they can ease pain and discomfort:
- Thoracentesis: If you have large pleural effusions, your physician may remove more fluid to ease symptoms.
- Chest tube (tube thoracostomy): Your physician will make a small incision in the chest wall and insert a plastic tube to remove excess fluid. The tube may be left in the pleural space for several days.
- Pleural drain: If the pleural effusions return, a long-term catheter can be inserted into your pleural space. The pleural effusions can be drained at home by you or a loved one. Your healthcare provider will provide instructions on how and when to perform this procedure.
- Pleurodesis: The doctor injects talc or doxycycline through a chest tube into your pleural space. The irritating substance will inflame your pleura and chest wall, which will bind to each other tightly to heal. Pleurodesis can prevent your pleural effusions from recurring in some cases.
- Pleural decortication: Surgery can be performed inside your pleural space. The surgery can remove inflamed and unhealthy tissues. Your surgeon can perform this procedure with large or small incisions.
Risks of Malignant Pleural Effusions Treatment
Treatment for some cases of this disorder can be handled with medication or related supportive care. For less severe cases, most patients recover in days or weeks. Minor problems can occur with invasive treatments, such as pain and discomfort, which will go away with time. But some cases of pleural effusion, such as those caused by asbestos exposure and mesothelioma, can involve more severe complications.
More serious complications include:
- Fluid in the lungs (pulmonary edema). This can happen if the fluid is drained too quickly during your thoracentesis.
- Collapsed lung
- Bleeding or infection
These complications are serious but rare. Your physician will determine the best treatment option for you.
Remember: If you have symptoms of pleural effusions, such as chest pain, dry cough, or difficulty breathing, talk to your healthcare provider immediately.