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.

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Mesothelioma can develop in the following areas of the chest:

• Pleural
• Peritonel
• Pericardial

Pleural mesothelioma – According to the American Cancer Society Pleural mesothelioma is the most common type, affecting 75 percent of sufferers and more typically males in the 60-80 age bracket and who have a history of exposure to asbestos.

The pleura consists of 2 layers of membrane, the inner layer (visceral) situated adjacent to the lung and the outer layer (parietal) lining the chest wall. These two membrane layers secrete fluid allowing them to smoothly slide over one another other during breathing.

When mesothelioma develops in the pleura the delicate membranes gradually become thickened and may press inwards on the lung.  A build-up of Fluid may occur between the two layers of the pleura, commonly known within the medical profession as a ‘pleural effusion’.

Symptoms of Pleural mesothelioma may include:

• Chest pain
• Shortness of breath – medical term – Dyspnea
• Persistant coughing – mild- chronic with or without blood

Pain can also be located in the upper abdomen area (just below the chest cavity) as well as the upper arm and shoulder.

Note – In some cases symptoms may not be present and the disease will only be picked up during a routine x-ray.

Peritoneal Mesothelioma – Symptoms of peritoneal mesothelioma may not manifest until 20 – 50 years after the initial exposure to asbestos and the peritoneum is the 2nd most common site where mesothelioma can develop and account for approximately one fifth of mesothelioma cases.

Peritoneal mesothelioma develops as a result of asbestos fibres travelling into the peritoneal layers causing irritation and inflammation. The fibres promote the development of cancerous cells where they continue to gradually divide. Tumours begin to grow and over time causes the peritoneum to thicken where fluid builds up within the peritoneal layer. The thickening and tumours of the peritoneum can cause pressure on organs within the abdomen resulting in bowel problems and distension due to obstruction and it can distend upward impairing breathing resulting in breathlessness.

Symptoms of Peritoneal mesothelioma may include:

• Upper abdominal pain (1st common symptom)
• Shortness of breath
• Cough

Pericardial mesothelioma – is the least common form of a mesothelioma occurring in only 10 percent of patients and affects the lining of the heart (pericardium). Medical research scientists and doctors are unsure as to how asbestos fibres become lodged in the serous lining of the heart or Pericardium, one theory being; the fibres break down to a minute size allowing them to be carried via the blood stream., and as the blood pumps through the heart, the fibres become lodged in the heart lining.

Accelerated growth of the cancerous tumours can result in tissue expansion and fluid build-up ultimately interfering with the normal function of the heart.

Symptoms of Pericardial mesothelioma are typically as follows:  

• Chest pain
• Irregular heartbeat

You can find a description of the different types of mesothelioma here <

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