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Symptoms of a Pleural Effusion

Pleural Effusion - Chest X-ray film
The first step to identifying pleural effusions typically involves the use of plain X-ray films

A pleural effusion does not cause any symptoms. Symptoms are more likely to be observed in the case of a moderate or large-sized pleural effusion, or in the event that there is an inflammation present. The most common symptom of pleural effusion is difficulty breathing or shortness of breath. As the effusion increases in size, the harder it becomes for the patient to breathe. Chest pain is another common symptom of pleural effusion which occurs due to irritation of the pleural lining of the lungs. This pain is typically described as a sharp pain that worsens with every deep breath that the patient takes. This pain will typically increase with as the pleural effusion becomes larger.

Other symptoms are due to the presence of an underlying disease. For instance, an individual suffering from pneumonia may experience chills, fever and a bloodstained cough, along with pleural pain. An individual with congestive heart failure may exhibit signs of feet swelling and shortness of breath when they are laying flat. Because pleural effusions typically occur as a result of underlying medical conditions, the symptoms of these conditions are often also present. Common symptoms of a pleural effusion are:

  • Fever
  • Chest pain, especially when the patient coughs or breaths in deeply (pleuritic pain or pleurisy).
  • Hiccups
  • Rapid breathing
  • Dry, nonproductive cough
  • Dyspnea – Shortness of breath or difficult, labored breathing
  • Orthopnea – The inability to breathe easily unless the person is standing erect or sitting up straight

Based on the symptoms of the patient and observations during the physical examination, the doctor may conclude that the patient is suffering from a pleural effusion. When the doctor suspects a pleural effusion is present, they may use maneuvers such as auscultation (examining the patient and listening with a stethoscope) or percussion (tapping on the chest). In most cases, a pleural effusion is detected by an imaging test. Some of the common tests used for the identification, diagnosis and evaluation of pleural effusions include:

  • Chest X-ray film: The first step to identifying pleural effusions typically involves the use of plain X-ray films. A pleural effusion will appear on the chest X-ray as a white space at the base of the lung. If a pleural effusion is likely to be present, additional X-ray films may be taken while the patient is lying on their side. These films are referred to as decubitus X-ray films and are able to show if the fluid is flowing freely inside the chest.
  • Computed tomography or CT scan: CT scanners are designed to rapidly take multiple X-rays, while a computer is constructing images of the interior of the chest. A CT scan produces more detailed information about a pleural effusion and other lung abnormalities than a chest X-ray would.
  • Ultrasound of the chest and heart: This involves placing a probe against the skin which reflects high-energy sound waves off the chest structures, thereby creating images on a video screen. Ultrasound is great for assisting to guide the draining of the pleural effusion, as well as identifying whether the pleural effusion is free-flowing.
  • Kidney and liver function blood tests
  • Pleural fluid analysis – This entails an examination of the fluid removed from the pleura space under a microscope while looking for cancer cells, bacteria and an amount of protein.

Once pleural effusions have been identified by the imaging tests, fluid samples are typically taken for purposes of determining the character and severity of the pleural effusion. During a procedure referred to as thoracentesis, the doctor will insert a needle and catheter between the patient’s ribs, and into the pleural space. They will then draw a small amount of fluid for testing. They may simultaneously remove a large amount of fluid in order to relieve symptoms.

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