This causes pulmonary edema and pleural effusions. In breast cancer CD44CD24 cells are detectable in metastatic pleural effusions. For example, severe heart failure can cause pulmonary edema, pleural effusions, ascites and peripheral edema. Pulmonary haemorrhage, pleural effusions, atelectasis, and intrapulmonary shunts also contribute to respiratory difficulty. Amylase may be elevated in pleural effusions related to gastric/esophageal perforations, pancreatitis or malignancy. Lumican is highly expressed in pleural effusions (lung fluid) of patients with adenocarcinoma. A decrease implies hypoventilation, as can occur with restrictive lung disease, pleural effusions or atelectasis. Exudative pleural effusions are also associated with RA. The goal of treatment of malignant pleural effusions is relief of shortness of breath. Third spacing conditions may include peritonitis, pyometritis, and pleural effusions. Ultrasonography may also be used to detect hemothorax and other pleural effusions. Simple pleural effusions occur in up to 40% of bacterial pneumonias. It is used in pleurodesis (fusion of the pleura because of incessant pleural effusions). For patients with malignant pleural effusions, it allows them to continue chemotherapy, if indicated. E-cigarettes have been correlated with pleural effusions.