Symptoms of Mesothelioma

What Is A Pleural Effusion?

A pleural effusion is an excessive accumulation of fluid that builds up in the pleural space, (chest cavity). The problem can only be detected on routine x-rays if 300ml or more fluid is present.

The pleura is a thin membrane that covers the lungs, it consists of an inner layer – that covers the lungs and an outer layer that lines the ribcage and diaphragm. The pleura secretes a lubricant that assists easier breathing by allowing the lungs to expand in and out smoothly.

The 1st case of pleural effusion was reported in 1964 by Eisenstadt, and is the most common asbestos-related disease to occur within the first decade after exposure to asbestos. Other conditions can also result in a pleural effusion.

Diagnosis

Diagnosis is carried out by ‘pleural aspiration‘. A needle attached to a 20ml syringe is inserted through an intercostal where an area of dullness is present. The drawn off fluid sample is then for protein estimation, cytology and bacteriological examination. If large amounts of fluid are present in the pleural space – this can be aspirated to relieve severe symptoms of breathlessness.

Fluid Results

The fluid results will be either:

• Transudate
• Exudate

Transudate effusions – can be bilateral, (on both sides), but are usually larger on the right side. Causes of transudate effusions include:

• Heart failure
• Hypoproteinaemia (nephotric syndrome)
• Constrictive pericarditis
• Hypothyroidism
• Ovarian tumours

Exudate effusions – causes include:

• Sarcoidosis
• Yellow-nail syndrome
• Familial Mediterranean fever
• Bacterial pneumonia
• Carcinoma of the bronchus
• Tuberculosis
• Connective-tissue disease
• Post-myocardial infarction syndrome
• Acute pancreatic
• Mesothelioma 

Treatment

If a diagnosis has not been determined by a simple aspiration sample then a biopsy will be carried out. Management of malignant pleural effusions require regular aspirations as fluid tends to reaccumulate.

A major part of treatment for pleural effusion is primarily concentrated on the underlying cause of the effusion. For instance – antibiotics for pneumonia, chemotherapy or radiotherapy for malignant tumours, and drugs for hypothyroidism etc. Therefore, treatment can vary greatly, depending on the cause of the effusion.