Pleural Effusion, Atelecatsis

A Pleural Effusion is a buildup of fluid in the space around your lungs.

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A Pleural Effusion is often associated with atelectasis (collapse of lung tissue ):

Atelectasis is an abnormal condition characterized by the collapse of lung tissue, preventing the respiratory exchange of carbon dioxide and oxygen. Atelectasis - a collapsed or airless state of the lung - may be acute or chronic, and may involve all or part of the lung. The primary cause of atelectasis is obstruction of the bronchus serving the affected area.

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Symptoms may include:

  • Shortness of breath
  • Chest pain, usually a sharp pain that is worse with cough or deep breathing
  • Cough
  • Fever

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Numerous medical conditions can cause pleural effusions. Some of the more common causes are:

  • Congestive heart failure
  • Pneumonia
  • Liver disease
  • Renal disease
  • Cancer
  • Pulmonary embolism
  • Lupus and other autoimmune conditions

Excessive fluid may accumulate because the body does not handle fluid properly (such as in congestive heart failure, or kidney and liver disease). The fluid in pleural effusions also may result from inflammation, such as in pneumonia, autoimmune disease, and many other conditions.

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  • Chest x-ray
  • CT scan
  • Thoracentesis (a sample of fluid is removed with a needle inserted between the ribs)
  • Pleural fluid analysis (examining the fluid under a microscope to look for bacteria, amount of protein, and presence of cancer cells)
  • ECHO

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Dressler's Syndrome
After heart surgery, the combination of a pleural effusion and atelectasis sometimes results into what is called a Dressler's Syndrome or Post-Cardiotomy Syndrome and occasionally happens after heart surgery.

Symptoms typically appear 2-3 weeks following surgery

  • May last for weeks or months
  • chest pain (91%)
  • Fever
  • Pericardial and pleural effusion

Three sequential images of the chest show a pre-op chest X ray in which the left lung base is clear (green arrow); on the third day post-op coronary artery jump bypass surgery, there is subsegmental atelectasis at the left base (yellow arrow). Four weeks later, there is a left pleural effusion and subsegmental atelectasis visible (red arrow).

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 General principle:Treat the medical condition causing the pleural effusion.

  • Antibiotics for pneumonia, or
  • Diuretics for congestive heart failure
  • Anti-inflammatory medications and steroids

Large, infected, or inflamed pleural effusions often require drainage to improve symptoms and prevent complications. Various procedures may be used to treat pleural effusions, including:

  • Thoracentesis or pleural tap, is a procedure to remove fluid or air (pneumothorax) from the pleural space

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  • Tube thoracotomy (chest tube): A small incision is made in the chest wall, and a plastic tube is inserted into the pleural space. Chest tubes are attached to suction and are often kept in place for several days.
  • Pleurodesis: An irritating substance (such as talc or doxycycline) is injected through a chest tube, into the pleural space. The substance inflames the pleura and chest wall, which then bind tightly to each other as they heal. Pleurodesis can prevent pleural effusions from reoccurring, in many cases.
  • Pleural drain: For pleural effusions that repeatedly reoccur, a long-term catheter can be inserted through the skin into the pleural space. A person with a pleural catheter can drain the pleural effusion periodically at home.
  • Pleural decortication: Surgeons can operate with tools inside the pleural space, removing potentially dangerous inflammation and unhealthy tissue. Decortication may be performed using small incisions (thoracoscopy) or a large one (thoracotomy).

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