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Overview of Malignant Pleural Effusion

written by: Harry Sylvester • edited by: Emma Lloyd • updated: 9/12/2010

Malignant pleural effusion can occur when cancer grows in the pleural cavity, producing excessive fluid there. It can result in difficulty breathing and chest pain. Learn what causes the effusion along with symptoms, diagnosis, and treatment.

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    Pleural Effusion

    Pleural Cavity Situated between the lungs and the chest cavity, the pleural cavity is the space containing the lungs, pleura, and pleural fluid. The pleura refers to a two-layered membrane surrounding the lungs and lining the inner wall of the chest cavity. It performs to protect the lungs as well. There is a space between two layers of the pleura containing pleural fluid to lubricate and enable the lungs to move well while breathing. Click on image to enlarge.

    A pleural effusion occurs when excessive fluid accumulates in the pleural cavity, then presses on the lungs, leading to difficulty breathing or shortness of breath. The lungs will not function normally at this time. Cancer can metastasize or spread to this cavity and produce excessive fluid. This condition is known as malignant pleural effusion.

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    Causes

    A complication of cancer can lead to malignant effusion. Some cancers such as lung cancer, leukemia, breast cancer, or lymphoma might result in this condition. Difficulty breathing owing to the effusion can reduce significantly by having the fluid in the chest cavity drained.

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    Signs and Symptoms

    Several symptoms that may occur include:

    • Difficulty breathing or shortness of breath (dyspnea)
    • Heavy pressing sensation on the chest
    • Dry cough
    • Chest pain
    • Fatigue
    • Fever

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    Diagnosis

    Some tests below can help diagnose the effusion in addition to determining the exact area of it:

    Thoracentesis

    The doctor inserts a needle between the ribs to drain the fluid from the pleural cavity. It can help decrease compression on the lungs. In addition, a microscope can detect and analyze the fluid if cancerous cells exist.

    Computed Tomography (CT) scan

    CT scan makes a series of x-ray images with the aid of a computer to produce 3-D images of the internal structures and organs of the body. The doctor might inject contrast material into a vein to help increase the distinction between areas of the body.

    Chest x-ray

    Chest x-ray produces an x-ray image of the chest and internal organs inside the chest. The test involves radiation to the chest, resulting in a detailed image of the chest.

    Biopsy

    The doctor performs a biopsy unless thoracentesis works well. A biopsy is the removal of tissues, then a microscope can check whether or not cancer cells are present. The doctor takes samples by performing a thoracoscopy or surgery to examine the inner organs in the chest. He or she makes an incision between two ribs and inserts a thin and lighted tube called a thoracoscope to take samples.

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    Treatment

    The following treatments are effective to drain the fluid from the chest:

    Surgery

    The doctor might perform surgery to insert a thin tube to relocate the fluid from the pleural cavity to the abdominal cavity. This procedure can help drain the fluid more certainly.

    Thoracentesis

    In addition to diagnosing the effusion, thoracentesis can be applied to treat it. This procedure involves a needle and/or a hollow plastic tube to collect the fluid from the pleural cavity. It will provide temporary relief from the symptoms, enable the lung to expand, and restore normal breathing.

    Pleurodesis

    It is a medical procedure to avoid the buildup of fluid in the space between the membranes in addition to allowing them to stick together. Once thorecentesis has removed fluid, then the doctor administers chemical agents like talc powder inside the space between the pleura. The aim of pleurodesis is to prevent the fluid from returning.

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    References

    Robert Wood Johnson University Hospital: Malignant Pleural Effusion - http://www.rwjuh.edu/medical_services/malignant_pleural_effusion_treatment.html

    The National Cancer Institute: Malignant Pleural Effusion - http://www.cancer.gov/cancertopics/pdq/supportivecare/cardiopulmonary/Patient/page3

    Cancer.net: Fluid around the Lung or Malignant Pleural Effusion - http://www.cancer.net/patient/All+About+Cancer/Treating+Cancer/Managing+Side+Effects/Fluid+Around+the+Lungs+or+Malignant+Pleural+Effusion+-+ASCO+curriculum

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    Photo Credit

    Image courtesy of the National Library of Medicine.

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