lung and airway disorders
Pleural Effusion
Treatment of Pleural Effusion
Treatment of the disorder causing pleural effusion Drainage of large pleural effusions Small pleural effusions may not require treatment, although the underlying disorder must be treated. Sometimes the person is given analgesics until the fluid is drained or drains away on its own. Larger pleural effusions, especially those that cause shortness of breath, may require drainage. Usually, drainage dramatically relieves shortness of breath. Often, fluid can be drained using thoracentesis. An area of skin between two lower ribs is anesthetized, then a small needle is inserted and gently pushed deeper until it reaches the fluid. A catheter (thin flexible tube) is often guided over the needle into the fluid to lessen the chance of puncturing the lung and causing a pneumothorax. Although thoracentesis is usually done for diagnostic purposes, doctors may use this procedure to remove enough fluid at one time to relieve the person's shortness of breath. When large amounts of fluid must be removed, a tube (chest tube) may be inserted through the chest wall. After numbing the area by injecting a local anesthetic, doctors insert a thin flexible tube into the chest between two ribs. Then doctors connect the tube to a water-sealed drainage system that prevents air from leaking into the pleural space. A chest x-ray is taken to check the tube’s position. Drainage can be blocked if the chest tube is incorrectly positioned or becomes kinked. If the fluid is very thick or full of clots, it may not flow out. When an accumulation of fluid is due to pneumonia, antibiotics are needed. Doctors also typically remove a sample of the fluid for examination and testing. If the fluid is pus or has certain other characteristics, the fluid needs to be drained, usually with a chest tube. If the fluid is partitioned into separate compartments by scars that have developed within the pleural space, drainage is more difficult. Sometimes drugs called fibrinolytic drugs plus a drug that can help thin effusions that are thick (dornase alfa) are instilled into the pleural space to help drainage, which may avoid the need for surgery. (To be effective, both fibrinolytic medications anddornase alfamust be used.) If surgery is needed, it can be done by using a procedure called video-assisted thoracoscopic debridement or by making an incision through the chest wall (thoracotomy). During surgery, any thick peels of fibrous material over the lung surface are removed to allow the lung to expand normally. Fluid accumulation caused by cancers of the pleura may be difficult to treat because fluid often reaccumulates rapidly. Draining the fluid and giving antitumor medications sometimes prevents further fluid accumulation. A small tube can be left in the chest so that the fluid can be drained periodically into vacuum bottles. But if fluid continues to accumulate, sealing the pleural space (pleurodesis) may be helpful. For pleurodesis, all fluid is drained through a tube, which is then used to administer a pleural irritant, such as adoxycyclinesolution,bleomycin, or a talc mixture, into the space. The irritant seals the two layers of pleura together, so that no room remains for additional fluid to accumulate. Pleurodesis can also be done using thoracoscopy. Treatment of chylothorax focuses on eliminating the leakage from the lymphatic duct. Such treatment may consist of surgery, chemotherapy, or radiation therapy for a tumor that is blocking lymph flow. 