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Pleural Effusion And Empyema

What is this Condition?

An excess of fluid in the pleural space is called pleural effUsion. The pleural space refers to the thin space between the lung tissue and the membranous sac (called the pleura) that protects it.

Normally, this space contains a small amount of fluid that lubricates the pleural surfaces. Increased production or inadequate removal of this fluid causes a pleural effusion. The accumulation of pus and dead tissue in the pleural space is called empyema. Blood in the pleural space is called hemothorax, and chyle in this space is called chylothorax.

What Causes it?

When an imbalance of pressures in the pleural capillaries occurs, excessive amounts of fluid can pass across intact capillaries. The result is known as transudative pleural effusion. Such effusions frequently are caused by heart failure, liver disease with ascites, peritoneal dialysis, and disorders resulting in too much blood in the vessels.

Exudative pleural effusions result when capillaries exhibit increased permeability, allowing fluid to leak into the pleural space. Exudative pleural effusions occur with tuberculosis, subdiaphragmatic abscess, pancreatitis, bacterial or fungal pneumonitis or empyema, malignant disease, pulmonary embolism with or without infarction, collagen diseases (lupus and rheumatoid arthritis), myxedema, and chest trauma.

Empyema is usually associated with infection in the pleural space.

What are its Symptoms?

People with pleural effusion usually show symptoms from the underlying illness. Most people with large effusions, particularly those with underlying lung disease, complain of shortness of breath. Those with effusions associated with pleurisy complain of chest pain. People with empyema also develop fever and malaise.

How is it Diagnosed?

Diagnosis depends on results from physical exam and chest X-ray. However, diagnosis also requires other tests to distinguish transudative from exudative effusions and to help pinpoint the underlying disorder. The most useful test is thoracentesis, in which a sample of pleural fluid is removed by needle and analyzed.

How is it Treated?

Depending on the amount of fluid present, symptomatic effusion may require thoracentesis to remove fluid, or careful monitoring of the person's own reabsorption of the fluid. Hemothorax requires drainage. Treatment of empyema requires insertion of one or more chest tubes after thoracentesis, to allow drainage of pus, and possibly surgical removal of the thick coating over the lung or rib resection to allow open drain­age and lung expansion. Empyema also requires antibiotics. Associated hypoxia (low level of oxygen in the tissues) requires oxygen administration.

What can a person with Pleural Effusion and Empyema do?

  • As instructed, do deep-breathing exercises to promote lung expansion and use an incentive spirometer to promote deep breathing .

  • If you developed pleural effusion as a complication of pneumonia or the flu, get prompt medical attention for chest colds.