Pleural Effusion

Pleural effusion

A pleural effusion can occur in various diseases, for example heart muscle weakness, various cancers, kidney failure, various inflammatory or infectious diseases and much more. Fluid accumulates in the gap between the lungs and the chest wall, more precisely between the pleura and the pleura, the so-called pleural gap. Usually it is very small and contains very little liquid. A pleural effusion becomes noticeable accordingly - among other things, through difficult breathing.

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What are the causes of a pleural effusion?

Pleural effusion can occur in various diseases. A fundamental distinction is made between diseases in which fluid enters the pleural space “passively” through increased filtration, such as cardiac insufficiency, renal insufficiency, hypoalbuminemia, liver failure with ascites. This is a low-protein liquid called a "transudate".

In other diseases, however, there is an increased production of protein-rich fluid, which is then referred to as "exudate". These diseases include on the one hand inflammatory diseases such as rheumatism and other connective tissue diseases, infectious diseases such as pneumonia or tuberculosis. Malignant tumors can also cause a pleural effusion through metastases on the pleura.

A pleural effusion can occur, for example, with:

• Malignant tumors (malignant processes, e.g. in bronchial or breast cancer),
• Heart failure (heart failure),
• Renal failure,
• Pneumonia (inflammation of the lungs)
• Pulmonary embolism (pulmonary embolism).

Pleural effusion is less common in other diseases, for example hypoalbuminemia, pancreatitis, rheumatic diseases, tuberculosis, etc.

What are the symptoms?

A pleural effusion manifests itself as:

• Difficult breathing (dyspnoea)
• Pain (with smaller pleural effusions, partly depending on the breath). Pain occurs in the context of the underlying cause, for example pneumonia, pulmonary embolism.

Depending on the underlying disease, various additional symptoms occur. For more information on symptoms, see the disease under Diseases.

How is the diagnosis made?

The doctor takes the medical history (anamnesis), asks about symptoms such as fever or cough, previous illnesses, etc. She / he carries out physical examinations, e.g. tapping and listening. It is essential to recognize the underlying disease (e.g. pulmonary embolism, infection, cardiac insufficiency, etc.) if this is not already known. X-rays and ultrasound are also arranged.

To determine if it is a transudate or an exudate, it may be necessary to take a sample of the effusion. This takes the form of a pleural puncture. The sample is taken using a needle and after local anesthesia. She gives the doctor initial information (e.g. about admixture of blood, pus). In addition, the sample is further examined in the laboratory. See Pleural Puncture for more information.

As part of the diagnosis of a pleural effusion, various laboratory values can be determined in order to narrow down the cause of the effusion (in particular protein, but also bacterial culture, cytological examinations, ESR, CRP, blood count, differential cell count, hematocrit, pH value, LDH). Further information on the laboratory values can be found under Laboratory values table.

The following examinations can also be carried out:

• CT
• Thoracoscopy (including pleural biopsy)

How is the treatment carried out?

The therapy is based on the cause and the size of the effusion and consists - in addition to treating the underlying disease - of the following measures:

• Puncture. In the course of the therapy, a puncture may be necessary, during which a large amount of the fluid that causes discomfort is removed.
• Drainage. The effusion is continuously "sucked off" through a small skin incision and a tube with the aid of negative pressure. After removing the drainage, the wound is closed with a plaster or a suture. The treatment is carried out in a hospital under local anesthesia.
• Pleurodesis (pleural bonding). The space between the pleura and pleura is "glued", for example with talcum powder over the drainage. This can be done in the course of an operation in which liquid can be sucked off beforehand, or by sterile instillation of talc solution (“talc slurry”) through an already installed drainage system.

The attending physician will inform you about the necessity and implementation of the therapeutic measures.

Further information on the treatment of certain diseases can be found under diseases.

Whom can I ask?

Contact persons for complaints or diseases of the lungs

• Specialists in lung diseases.
• The family doctor can initiate referrals if necessary (e.g. for further examinations).

Doctors from various other specialties can be involved in the diagnosis and treatment, e.g. for surgery, internal medicine, etc.

Pleural functions (in most cases), drainage and pleurodesis are performed in the hospital.

Note If symptoms such as shortness of breath, sudden pain in the chest area (especially when breathing deeply) or severe pain, the emergency doctor (144) must be notified immediately!

How are the costs going to be covered?

The e-card is your personal key to the benefits of the statutory health insurance. All necessary and appropriate diagnostic and therapeutic measures are taken over by your responsible social insurance agency. A deductible or contribution to costs may apply for certain services. You can obtain detailed information from your social security agency. Further information can also be found at:

• Right to treatment
• Visit to the doctor: costs and deductibles
• What does the hospital stay cost?
• Prescription fee: This is how drug costs are covered
• Rehabilitation & cure
• Medical aids & aids
• Health Professions AZ

and via the online guide to reimbursement of social insurance costs.