Malignant Pleural Effusion | White Plains Hospital

Malignant Pleural Effusion

A pleural effusion is a collection of fluid that occurs in the space between the lung and the inside of the chest wall. The pleural cavity is the space that exists between the pleura which is a thin layer of tissue covering the surface of each lung and lining the inner surface of the chest cavity. Normally, the pleural tissue makes a small amount of fluid referred to as pleural fluid that lubricates the connection between the lung and the chest wall and allows the lung to move smoothly during breathing. When there is extra fluid in this cavity it is referred to as a pleural effusion. When a cancer spreads to the lining of the chest or pleura, this can cause a pleural effusion. When this increased fluid production is caused by a malignancy and there are malignant cells in the fluid, it is referred to as a malignant pleural effusion.

Symptoms

  • Shortness of breath or dyspnea
  • Shortness of breath on exertion or exertional dyspnea
  • Cough
  • Pain in the chest wall or discomfort

Diagnostic Tests

  • Chest x-ray - this is a simple x-ray which can frequently diagnose moderate sized effusions
  • CT scan of chest - because this is a more detailed study of the chest, small effusions can be identified as well as other disease processes
  • Thoracentesis - a thoracentesis is a diagnostic procedure where a small needle is placed into the chest using local anesthesia allowing for the removal of some or all of the fluid. The fluid is analyzed and if cancer cells are identified within the fluid, then the diagnosis of a malignant pleural effusion is confirmed.
  • Minimally Invasive Thoroscopic Surgery (VATS) - this is a procedure where through several small incisions a scope is inserted into the chest cavity. This not only allows for the diagnostic removal of fluid or the biopsy of abnormal tissue, but may also be continued to perform a therapeutic option.

This is a CT scan showing a left side effusion that has completely collapsed the left lung.
This is a CT scan showing a left side effusion that has completely collapsed the left lung.

Treatment

  • Thoracentesis - thoracentesis allows for removal of fluid from the chest cavity. If there is reaccumulation of the fluid, the procedure can be repeated.
  • Pleurodesis - a pleurodesis is a procedure designed to cause the lung to be scarred to the chest wall thereby obliterating the pleural space. With the pleural space obliterated, there is no space left for fluid accumulation. A pleurodesis can be chemical or mechanical.
    • Chemical pleurodesis - in a chemical pleurodesis a substance is instilled into the pleural space which causes an inflammatory response leading to the scarring of the pleura lining the lung to the pleura lining the chest wall. Drugs such as bleomycin or talc can be used. The drugs can be instilled through a small tube placed into the chest or during a surgical procedure.
    • Mechanical pleurodesis - in a mechanical pleurodesis the pleural surfaces that line the lung and the chest wall are abraded to cause bleeding. This leads to the two surfaces sticking together and diffusing. This requires a surgical procedure.
  • Minimally Invasive Thoroscopic Surgery (VATS) - in a VATS procedure, several small incisions are made into the chest and a scope inserted. The malignant fluid is removed and if necessary biopsies of tissue are performed. A mechanical or chemical pleurodesis can then be performed. In addition, catheters may be left in place if this is deemed appropriate.
  • Chronic Indwelling Pleural Drainage Catheter - in order for chemical or mechanical pleurodesis to be successful, the lung must be able to expand and touch the chest wall. Occasionally, in the presence of a malignant pleural effusion, the lung is unable to expand completely and in that case a pleurodesis will not be successful. In that instance, a small catheter can be left in place to allow the patient to drain any accumulating fluid on their own. This allows the patient to go home with a small catheter that can be cared for and the patient can resume relatively normal activities.

At White Plains hospital we have a fully staffed thoracic surgery service that includes board-certified thoracic surgeons, anesthesiologists, pulmonologists, and critical care intensivists as well as highly trained nurses, respiratory therapists, physical therapists, social workers, and caseworkers who work hand-in-hand with your surgeon in providing the best and most individualized care for you.