Pleural Effusion (Fluid Around the Lungs) Treatment

"There's water in the lungs"

That's how most families first hear about it. Strictly speaking, the fluid is usually not inside the lungs but around them. The lungs are wrapped in two thin layers called the pleura, with a small amount of lubricating fluid in between. When too much fluid collects in that space, it's called a pleural effusion.

The fluid presses on the lung from outside, so it can't expand fully. That's why the main symptom is breathlessness, often with a heavy or tight feeling on one side of the chest.

Removing the fluid gives relief. But the more important question is always: why did it collect in the first place?

Symptoms

• Breathlessness, which gets worse as more fluid builds up
• Chest pain, often sharp and worse on deep breathing or coughing
• A dry cough
• Fever, if infection or TB is the cause
• Difficulty lying on one side

Small effusions may cause no symptoms and are picked up only on an X-ray done for another reason.

Common causes

In India, the list of common causes is slightly different from Western textbooks.

• Tuberculosis. One of the most common causes of pleural effusion in younger adults in India. See TB treatment.
• Pneumonia with fluid collecting next to the infected lung (parapneumonic effusion), which can turn into pus (empyema). See pneumonia.
• Heart failure. Often on both sides, with swollen feet and breathlessness on lying flat.
• Kidney or liver disease, which causes fluid build-up in various parts of the body.
• Cancer, either starting in the lung or spreading from elsewhere, such as breast or ovary.
• Less common causes: pulmonary embolism, autoimmune diseases, pancreatitis, and some medicines.

How we find the cause

Imaging

A chest X-ray shows the fluid. A chest ultrasound is very useful: it shows exactly how much fluid there is, whether it is in pockets, and the safest spot to put in a needle. A CT scan helps look at the lung underneath and the pleura itself.

Pleural tapping (thoracentesis)

This is the key step. A thin needle is passed between the ribs, usually from the back while you sit leaning forward on a table, and some fluid is drawn out. The skin is numbed with local anaesthetic first, so it is generally well tolerated. Ultrasound guidance makes it safer and more accurate.

The fluid is sent for tests: protein, sugar, LDH, cell count, ADA (useful for TB), cultures, and cytology to look for cancer cells. These results usually tell us which group of causes we're dealing with.

If larger amounts of fluid are causing breathlessness, more is removed in the same sitting for relief. This is called therapeutic tapping. Most people breathe noticeably easier right after.

Further tests

If the fluid tests don't give a clear answer, a pleural biopsy or medical thoracoscopy (a camera passed into the chest through a small cut) may be advised to take samples directly from the pleura. Dr. Bedi performs thoracoscopy as part of his interventional pulmonology work.

Pleural tapping, chest drain (ICD) placement and thoracoscopy are done at Paras Health, Panchkula, not at the Sector 20 clinic.

Treatment

Treatment is aimed at the underlying cause:

• TB pleural effusion: standard anti-TB treatment; the fluid often settles over weeks as treatment works
• Infected effusion or empyema: antibiotics plus drainage, sometimes with a chest tube (intercostal drain, ICD) for several days
• Heart, kidney or liver-related effusion: treating the main condition with diuretics and other medicines, usually with the relevant specialist
• Effusion due to cancer that keeps coming back: options include repeated tapping, pleurodesis (sealing the pleural space so fluid can't collect), or an indwelling pleural catheter that allows drainage at home

After pleural tapping

• Mild soreness at the needle site for a day or two is normal
• A cough during or after the procedure is common as the lung re-expands
• A chest X-ray may be done afterwards to check the lung
• Report increasing breathlessness, chest pain, or fever promptly

Serious complications are uncommon, especially when ultrasound is used. The main risks are a small air leak (pneumothorax), bleeding, and infection.

Breathing exercises during recovery

Once fluid is removed, deep breathing exercises and an incentive spirometer, if one is given, help the lung expand fully again and reduce the chance of the pleura sticking down.

Consultation in Panchkula

If an X-ray shows fluid, or you've been told you need a pleural tap, Dr. Manan Bedi can evaluate you at Booth 194, Sector 20, Panchkula. He sees patients from Chandigarh, Mohali and Zirakpur, Monday to Saturday 5–7 PM and Sunday 11 AM–2 PM. Bring your X-ray, ultrasound and any fluid reports. Call +91-99280 14284 or book online.