Pleural Effusion
A pleural effusion is the accumulation of fluid in the pleural space, which is the space between the lung and chest wall. This space always has a small amount of fluid, but additional fluid can build up in this space due to an imbalance in pressures or an increase in permeability. Factors that can cause an increase in pleural fluid accumulation include but are not limited to; Congestive heart failure, renal failure, cirrhosis, malnourishment, lung collapse (pneumothorax), pneumonia, lung tumor/cancer, and/or other cancers.
Effusions can be classified different ways. It is important to know if an effusion is caused by cancer (malignant) or if it caused by something else.
Signs and Symptoms:
- Shortness of breath
- Cough
- Chest pain
Interventions
We help treat more complicated effusions; pleural effusions that continue to recur after being drained and/or effusions that are chronic. The following interventions are either to remove the fluid, prevent the re-accumulation of fluid, or to help the lung re-expand after fluid has been there for a prolonged period of time.-
Thoracentesis
A thoracentesis can be performed as an outpatient or inpatient procedure and is usually performed by our Interventional Radiology Department. This is a percutaneous procedure to remove pleural fluid with a needle or catheter under image-guidance (ie by visualizing the fluid using ultrasound or CT scan).
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Pleurodesis
A pleurodesis is a procedure performed as an inpatient where we instill an agent (medication or talc) into the pleural space that causes inflammation and fibrosis. This is sometimes performed during a VATS or we will ask our Interventional Radiology department to insert a chest tube through which we can instill the medication at the patient’s bedside.
A video assisted surgery is a minimally invasive lung surgery where the surgeon creates multiple small incisions in the chest and uses a video camera that sees into the chest in order to perform the procedure. Performing a VATS procedure will accomplish the same anatomic dissection as an open thoracotomy approach. -
PleurX catheter insertion
A PleurX catheter is an indwelling pleural catheter that a patient can manage at home. The patient and/or caretaker drains the pleural fluid per our surgeon’s recommendations in their home versus in the hospital setting. Inserting the catheter can be performed as an outpatient procedure and our office ensures the patient is equipped with the education and supplies needed to manage the effusion once the PleurX is placed. -
Decortication
A decortication is a surgery performed with the goal of draining all areas of fluid and allowing for lung expansion. This surgery is typically reserved for more complicated, benign pleural effusions and is performed via VATS or open thoracotomy. The surgeon removes fibrous peel from the pleura in an attempt to allow full lung expansion.
An open thoracotomy is an invasive surgical approach where the surgeon may make one or more large incisions through the chest wall to access the area(s) of concern.A video assisted surgery is a minimally invasive lung surgery where the surgeon creates multiple small incisions in the chest and uses a video camera that sees into the chest in order to perform the procedure. Performing a VATS procedure will accomplish the same anatomic dissection as an open thoracotomy approach.