Pleural Effusion - Fluid Collection in the Pleura - Thoracic Surgery - Lung Cancer Surgery

What is a pleura?

akciğe — The lung membrane we call the pleura is actually an organ in its own. It basically consists of two parts (also called two sheets). The first is the ‘Visceral Pleura’ which covers the entire outer surface of the lung and the other is the ‘Parietal Pleura’ which covers the inner surface of the chest, mediastinum and diaphragm. These 2 pleural parts are connected at the root of the lung, which we call the hilus, and form a closed sac as a whole. This pleural sac normally contains a very small amount of fluid, which allows the lung to move freely within the rib cage during breathing.

What are the causes of pleural effusion? Why fluid collects in the lungs?

What is known as fluid collection in the lung is actually the collection of fluid between the pleural leaves. It is defined as pleural fluid or pleural effusion. The lung has a spongy structure and there is no place for fluid to collect because there is no obvious space inside. There can only be what we call pulmonary edema in the lung (like a sponge retaining water), which is completely different from pleural fluid.
Pleural fluid collection can be seen in lung diseases, but pleural fluid collection can also occur due to many causes other than lung diseases. The main causes of pleural fluid collection are infectious diseases of the lung (pneumonia, tuberculosis), lung malignancy and some other rare lung tissue diseases. In fact, pleural fluid collection due to extrapulmonary causes is much more common. Pleural effusion can be seen in many diseases of the heart, kidney, liver, protein imbalance in the blood, or as metastasis of any cancer in the body to the pleura.

Is pleural effusion dangerous? What are the symptoms of pleural effusion?

Fluid collection in the pleura is important in two ways. Firstly, there is a disorder that causes this fluid collection, in other words, pleural fluid collection is the result of a disease. It therefore alerts us to treat the disease that is causing it. The other importance is that when fluid accumulates in the pleura, since the chest cavity is a closed cage, the accumulated fluid will put pressure on the lung (partly on other organs in the chest cavity) and cause the lung to shrink and not ventilate well. As a result, patients will experience symptoms such as shortness of breath, blunt pain in the chest and easy fatigue.
In other cases, malignant diseases of the lung or some other organs (breast, lymphatic system, etc.) may cause malignant fluid accumulation in the pleura, which may cause severe shortness of breath in the patient.

Can pleural effusion be treated?

When fluid accumulates in the pleura, depending on the disease causing it, medical treatments are used to try to regress and improve the fluid, if possible. Most of the pleural fluids are treated with medication. However, in both malignant diseases and some benign diseases that do not improve with other treatments, when massive fluid accumulates in the pleura, it may be necessary to drain this fluid by surgical intervention. For this purpose, it may be necessary to place drains of different diameters from thin to thick in the pleural cavity. Especially in the case of a malignant effusion, there may be very stubborn fluid collections, which can be very difficult to treat. In such cases, endoscopic (VATS) procedures can be used to peel the pleura and/or to create adhesion between the pleura and the chest wall (pleurodesis).
If infected fluid collects in the pleura, it will be necessary to drain it in addition to antibiotic treatment.

Can pleural effusion recur?

Unless the disorder causing pleural effusion is treated, the fluid will accumulate again after a while, even if the fluid is drained from the pleura. Therefore, the disease that causes pleural effusion must be treated first. Since pleural effusion due to malignant causes will also tend to recur, surgical interventions may be necessary to prevent recurrence.

Which surgical interventions can be performed for pleural effusion?

– Drainage applications with thin (millimeter thick) catheter
– Placement of thicker thoracic tubes into the pleural cavity,
– Pleural peeling (pleurectomy) or gluing of pleural leaves (to leave no space for fluid to collect in the pleura) with videothoracoscopic methods
– Indwelling pleural catheter applications for unresolving and recurrent pleural fluids.