Pleural effusion (accumulation of fluid in the pleura) and pleural puncture

What is it about ?

The pleura is a double membrane that covers the lung. One membrane lines the rib cage (the ribs and muscles between the ribs), it is called the parietal pleura (‘parietal’ for wall), the other membrane lines the lung, it is called the visceral pleura (the lung is a viscera). The term ‘the pleura’ is therefore used, either to speak of the double membrane, or to speak of only one of these two membranes.

When breathing, these two membranes slide against each other. They allow the lungs to fill up during inspiration, and to empty during expiration.

In the normal state, there is a tiny bit of liquid between the two membranes. Sometimes an abnormal buildup of fluid occurs between these membranes. We then speak ofpleural effusion.

The possible causes are:

• an underlying disease (heart failure, liver cirrhosis, pulmonary embolism…);
• a disease associated with inflammation of the pleura (pneumonia, lung disease due to asbestos, lung cancer, pulmonary embolism, tuberculosis);
• certain medicines (for example: certain anti-epileptic medicines).

How to recognize it?

The main symptoms areshortness of breath (dyspnea), cough, fever and pain on the side of the chest. Additionally, there may be symptoms that are specific to the underlying disease. Thus, inflammation or infection may be associated with fever, pneumonia with cough, and heart failure with swelling of the feet (edema).

How is the diagnosis made?

The doctor can detect abnormalities when auscultating the lungs. The diagnosis is confirmed on an x-ray of the lungs. It is almost always necessary to do additional tests (blood test and exam of the heart and lungs) to detect the underlying disease.

A pleural puncture is usually carried out. It consists of taking fluid under local anesthesia. Examining this fluid can help in the diagnosis. At the same time, this intervention reduces the pressure in the rib cage. The puncture can be repeated if necessary.

Want to know more?

• The pleura (drawing) – formationambulancier.fr
• What is a pleural puncture? – Health Passport
• The radiography, here, Where to find on this page of Cliniques St Luc UCL

Source

Foreign clinical practice guide ‘Pleural effusions and thoracentesis’ (2000), updated on 19.08.2016 and adapted to the Belgian context on 23.06.2019 – ebpracticenet