Treatment for Pleural Effusion

The aim of treatment for pleural effusion is to first remove the fluid and prevent it from building up again. If there is an underlying cause for the fluid buildup, the treatment is aimed at dealing with that underlying cause. If the fluid collection is large, a procedure known as therapeutic thoracentesis is performed. This is a minimally invasive process in which a large needle is inserted into the chest, right between the ribs. The fluids are removed from the chest with the help of this needle. However, the fluid may build up again if the underlying cause is not treated; therefore this is usually used only as a quick fix solution for pleural effusion. This, however, can offer temporary relief, by offering enough space for the lungs to expand and restore normal breathing as well as respiration. In case, the pleural effusion is causing uncontrollable respiratory symptoms, a chest tube may be inserted into the thoracic cavity and the fluids are removed. This is known as tube thoracostomy.

If pleural effusion has been caused due to congestive heart failure, diuretics and heart failure medications may be able to help drain the fluids on their own. In case the fluids have become malignant, further treatment may be required using chemotherapy. Medication infusion inside the chest or radiation therapy may also be used for the treatment of pleural effusion.

In some cases, the effusions can recur or become uncontrollable because they become malignant. Despite drainage, the fluid may continue to build up and a long term treatment plan may have to be instituted. In such cases, a sclerosing agent, a drug that may induce scarring, may be used. The drug is introduced into the pleural cavity through a tube during the thoracostomy process to create excessive fibrous tissue. The resulting pleural sclerosis may prevent recurrence of the effusions, but it is successful only 50% of the times. Therefore this method is used sparingly, only in cases where nothing else works.

Surgery is usually used as a last resort. When pleural effusions cannot be managed with drainage or medications, surgery is performed. Surgical treatment is performed to remove the fluid buildup and keep recurrences in check. There are two types of surgeries that may be performed for this. First is video-assisted thoracoscopic surgery (VATS), which is minimally invasive and requires only two to three small incisions in the chest. An antibiotic or a sterile talc may be used to prevent fluid buildup during this surgical process.

The second type of surgery is thoracotomy, which is nothing but an open thoracic surgery. A large incision of about 6 to 8 inches may be made on the chest and the fibrous tissue is removed with surgical instruments. This is the best resort in case the pleural effusion is accompanied by infection. The patient is required to use chest tubes in this surgical method for the next two weeks. These chest tubes are used to drain fluid continuously over the period of the next few weeks. This also ensures there is no recurrent buildup.

Your doctor will evaluate your particular condition and advise the surgical or treatment recourse depending on that.

Frequently asked questions
  1. R.W. Light, Y.C.G. Lee, PLEURAL EFFUSIONS | Overview, In:   Geoffrey J. Laurent and Steven D. Shapiro, Editor(s)-in-Chief, Encyclopedia of Respiratory Medicine, Academic Press, Oxford, 2006, Pages 353-358, ISBN 9780123708793, 10.1016/B0-12-370879-6/00299-4.
  2. Jeffrey S. Pollak, Catherine M. Burdge, Melvin Rosenblatt, Jeffrey P. Houston, Wen-Jen Hwu, John Murren, Treatment of Malignant Pleural Effusions with Tunneled Long-term Drainage Catheters, Journal of Vascular and Interventional Radiology, Volume 12, Issue 2, February 2001, Pages 201-208, ISSN 1051-0443, 10.1016/S1051-0443(07)61826-0.