​​​Pleural Effusion

Pleural Effusion is an abnormal build-up of fluid in the space around the lungs. Two thin membranes, known as the pleura, line the surface of the lungs and the chest. If you have pleural effusion, the space between these membranes gets filled with excessive fluid.

There are a number of causes of pleural effusion:

  • Heart failure

  • Tuberculosis

  • Pneumonia

  • Pulmonary embolism (blood clot)

  • Cancer

  • Liver disease

  • Nephrotic syndrome (a type of kidney disorder)

  • Autoimmune diseases such as lupus (where the body’s own immune system attacks itself)

There are two types of pleural effusions. The first is known as transudative pleural effusion, and is caused by fluid leakage into the pleural space due to an increased pressure in the blood vessels or low levels of protein in the blood. The other is exudative pleural effusion, caused by tumours, infection/inflammation and lung injury.​

Pleural effusion may often be asymptomatic. When present, symptoms include: 

  • Chest pain

  • Coughing

  • Shortness of breath

  • Fever

  • Difficulty in breathing

  • Hiccups

As mentioned, a pleural effusion is usually caused by an underlying condition such as heart failure, pneumonia, cancer or liver disease, so symptoms of these diseases may also manifest themselves.​

If you are experiencing chest pain, coughing, shortness of breath or difficulty in breathing, visit your doctor immediately. These symptoms might indicate an underlying problem that requires immediate medical attention. The Heart, Lungs and Vascular services at The Aga Khan University Hospital is committed to providing quality treatment and provides multidisciplinary medical care under one roof.​
Your time with your doctor may be limited, so makes sure to prepare for your visit beforehand. Here ​​are some tips to help get you started. ​​

If your doctor suspects a pleural effusion, he/she will elicit a medical history, as well as perform a physical examination. Tests for pleural effusion include:

  • Chest X-ray – a detailed image of your heart and lungs is captured by an X-ray machine which the doctor examines to check for the presence of fluid.

  • Blood tests may be conducted to check for infection or signs of underlying diseases such as lupus. 

  • ECG/EKG (Electrocardiogram) - this procedure is used to test your heartbeat to detect unusual patterns.

  • Cardiac CT (Computerized Tomography) scan – this provides images of your heart and lungs to show if there are any signs of clotting or other causes of pleural effusion. 

  • Ultrasound – In this procedure, high frequency sound waves are used through a device known as a transducer. These waves create a moving image on a computer screen, which can then be checked for the presence of clots, excessive fluids or other abnormalities.

Additional procedures may sometimes be necessary. These include:

  • Thoracentesis: Your doctor will inject a local anaesthetic between your ribs and then insert a needle through your chest wall to remove fluid and send for laboratory analysis. 

  • Pleural biopsy: This procedure is done to remove a sample of pleural tissue for examination under a microscope. 

  • Medical Pleuroscopy: This procedure is performed under local anaesthesia and sedation. During this procedure a sample of pleural tissue is obtained for further testing under direct visualization with a camera. 

  • Chest tube placement (tube thoracostomy): Sometimes a chest tube may need to be placed in the pleural effusion, e.g. with bad infections or recurrent pleural effusions.

  • Surgery: This can be performed for diagnostic or therapeutic purposes.​​

Treatment focuses on the underlying cause of the pleural effusion. If the cause of the fluid build-up is heart failure, your doctor may prescribe water pills (known as diuretics) or other medications to treat heart failure. If it is caused by infection, then your doctor will prescribe antibiotics. If the cause is cancer or infection, it may require drainage of the fluid using a chest tube. This is a more drastic measure and is usually done if the fluid is causing severe chest pain, shortness of breath or other severe problems. Once the fluid is removed, it allows the lung to expand and makes it easier to breathe. 

Further treatments, depending on the cause of the effusion, include:

  • Surgery

  • Radiotherapy (using high-powered X-rays or other radioactive particles to kill cancer cells)

  • Chemotherapy (treatment used to kill cancer cells)

  • Injecting medication into the chest to prevent further fluid from building up (pleurodesis)​​

The Aga Khan University Hospital offers various support services to help with managing or recovering from the disease or condition. These include but are not limited to nutrition, physiotherapy, rehabilitation, specialized clinics and some patient support groups. Your doctor or nurse will advise you accordingly.

The Aga Khan University Hospital offers financial assistance to those who are in need and fulfil the eligibility criteria. For further information, you can contact the Patient Welfare Department. You can find the contact number of the Patient Welfare Department in the 'Important Numbers' section on the website homepage.

The financial counselling staff is available during office hours, at the main PBSD (Patient Business Services Department), to answer your financial queries on treatments' costs and authorize admissions on partial deposit as per hospital policies allow. The financial counsellor in the emergency room is open 24/7. You can find the contact number of the Patient Business Services in the 'Important Numbers' section on the website homepage.​

Your doctor and or nurse will give you specific instructions about the prescribed medication. Please ensure that you take or use the prescribed medicine as advised. It can be dangerous to your health if you self-prescribe. Please inform the doctor or nurse beforehand if you have experienced any adverse reactions to any medications in the past. If you experience any symptoms of drug poisoning, overdose or severe reaction please contact the Pharmacy Service at The Aga Khan University Hospital immediately. You can find the contact number of the Pharmacy Services in the 'Important Numbers' section on the website homepage.​
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​​The information provided on our website is for educational purposes and not intended to be a substitute for medical advice, diagnosis or treatment. You should always seek the advice of your doctor or other healthcare professional provider.