What is the treatment for a pleural effusion?
A major part of treatment is usually directed to the underlying cause of the build-up of fluid between the lung and the chest wall.
- Antibiotics to treat pneumonia
- Chemotherapy or radiotherapy to treat cancer
If the underlying cause can be successfully treated then there is a good chance the pleural effusion will disappear for good. If the underlying cause cannot be treated or can only be partially treated then the effusion may return even if cleared.
How do you treat the effusion itself?
Small effusions that cause no symptoms or only mild symptoms may just be left and observed. Treatment is only needed if the effusion causes symptoms such as breathlessness.
A large pleural effusion that makes a person breathless can be drained. This is called a pleural fluid aspiration or pleural tap.
Draining a pleural effusion
A pleural effusion is usually drained by putting a tube known as a chest drain into the chest. This procedure is carried out by a medical specialist. The Patient is asked to sit down and then lean forward over a table with a pillow on it so their back is exposed. The patient will then be given an injection of local anaesthectic to numb the area and a small cut will be made in the chest and the chest drain will be inserted into the space where the fluid is collecting. Once in position the chest drain is attached to a bag or bottle for the fluid to drain into. The fluid that drains may be bloodstained. Usually the fluid will be drained off fairly slowly as a sudden release of pressure in the chest can cause a drop in blood pressure. This procedure usually requires a stay in hospital for a couple of days. There may be some pain when the anaesthetic wears off.
Once the drainage has slowed down and medical specialists believe most of the fluid has drained, the patient will have a chest x-ray to see how well the lung has responded and reinflated.
If there is only a small amount of pleural fluid in the chest, the Doctor may insert a small needle or cannula into the chest rather than a chest drain.
If the lung re-inflates after the fluid has been drained, it may be possible to seal the two layers of the pleura together to prevent the fluid from building up again. This is known as pleurodesis. It is usually done using sterile talc that is injected through the drain. After a pleurodesis the drain will remain in place for 24 hours.
60-90% of patients who undertake pleurodesis are successful ‘sealed’ no reoccurring pleural effusions.