Pleural effusion is a condition where there is excessive fluid formation in the pleural spaces. Pleural space refers to the area between the two layers that cover the lung. When the rate of formation of this fluid is more than the rate of absorption, accumulation occurs, leading to shortness of breath and breathing difficulty and a faster heart beat. When plural effusion is diagnosed, a chest X-ray is performed to confirm the presence of the fluid. Ultrasound may be performed to identify small pockets of fluid accumulation and the physician may perform a thoracentsis, guided by ultrasound to aspirate pleural fluid for investigation. Biochemical investigation of the fluid reveals its chemical composition, and microscopic and microbiological examinations identify bacterial infections, cancer cells, and other conditions. Read more on paracentesis procedure.
Analysis of the fluid removed in a pleural effusion test determines whether the fluid is a transudate or an exudate. Transudate effusions are caused by a change in the systemic parameters that affect the formation and absorption of fluid. Exudate effusions are the result of local factors such as infections that affect the absorption of the fluid. A pleural effusion procedure may be performed to relieve a patient with congestive heart failure, as fluid accumulation is common in such cases. Patients with liver problems like cirrhosis also are likely to have fluid accumulation on the right side. Bacterial pneumonia, tuberculosis, pleurisy, and malignancy may all be causes of exudative pleural effusions. Pleural effusion procedure to drain the fluid may be necessary for a patient with pneumonia who shows rapid accumulation of fluid. In cases where the patient has trouble breathing because of the fluid, a thoracic surgeon may recommend a chemical pleurodesis to prevent a recurrence of the condition in future.
A tube thoracostomy may be advised if the fluid in the pleural cavity is thick as in empyema or complicated parapneumonic effusion, where pus indicating infection, is present. When the fluid collected in pleural effusion testing appears bloody, it could be caused by malignancy, tuberculosis, pulmonary embolism, or pancreatitis. Since pleural effusions could be caused by any one of a number of systemic disorders, analysis of the fluid to determine if it is transudate or exudate and using clinical judgment to correlate findings from other diagnostic tools plays a vital role in deciding on the course of treatment. For instance, drug induced pleural effusion can be resolved by discontinuing the use of the drug identified as the cause.