The first thing Mrs. G said when she came for the evaluation of her pleural effusion was “I have been active all my life”. However, the simple task of bending over to tie her shoes had become impossible because she could not breath. She described the build up of fluid as terrifying and robbing her of her independence.
The accumulation of pleural fluid or fluid around the lung is a common problem which can occur in a number of disease states. The most common symptom associated with pleural fluid is shortness of breath. It is our goal to rapidly manage and effectively control this problem and restore independence to every patient.
As the fluid built up around Mrs. G’s lung, she described a sensation of shortness of breath and a complete inability to take a deep breath. She said she could no longer exercise; walking was taxing and the shortness of breath made it impossible for her to lay flat at night; she was now sleeping upright in a recliner. In the office, under ultrasound guidance, she had her fluid drained – improving her breathing “almost immediately”. We then formulated a plan to restore her independence and give her control over the accumulation of the fluid.
What is a pleural effusion?
The pleural space is the sac in which the lung sits. A pleural effusion is the accumulation of fluid in this sac, around the lung. Another way to look at this is like when you are going to the grocery store and getting your groceries in a double plastic bag. The groceries are the lung and the space in between the two plastic bags is the pleural space. The fluid does not accumulate in the lung; instead, it accumulates in between the two plastic bags.
There are many causes of fluid build up in that space including many cancers such as breast cancer or lung cancer. Other causes include heart failure or kidney failure. Pneumonia is also a common cause. Pleural fluid can accumulate once or re accumulate rapidly depending on the disease and the cause.
The goals of managing a pleural effusion include making a diagnosis, relieving the shortness of breath and restoring independence and control. The three most common strategies for managing a recurrent pleural effusion include ultrasound drainage (thoracentesis), the insertion of a tunneled pleural drain for home drainage or the instillation of talcum powder to obliterate the pleural space and stop fluid accumulation. There are pros and cons to each strategy and it is our goal in the Center for Pleural Diseases at the Swedish Cancer Institute to find the most appropriate strategy tailored for each individual.
Mrs. G had her pleural fluid drained and the next time it accumulated she had a tunneled pleural drain placed through a simple outpatient procedure. She now has power over her pleural fluid and drains the fluid on her schedule, not allowing it to build up and cause any shortness of breath. She is back at work and playing tennis.
While the underlying disease may remain a challenge, the symptoms of shortness of breath, pain or chest tightness caused by a pleural effusion should never leave your control.