From the Guidelines
Leaving a pleural effusion untreated for a long time can lead to severe complications, including respiratory failure, infection, and permanent lung damage, emphasizing the need for prompt treatment. The fluid accumulation in the pleural space can progressively compress the lung, causing increasing shortness of breath, decreased oxygen levels, and respiratory failure in severe cases. If the effusion is due to infection (empyema), the contained bacteria can multiply, leading to systemic infection, sepsis, and formation of loculations or fibrous tissue that can permanently trap the lung. Chronic effusions can cause pleural thickening and fibrosis, resulting in a restrictive lung disease pattern with permanently decreased lung function. Additionally, untreated malignant effusions may allow cancer to spread further.
According to the most recent guidelines, treatment should be initiated promptly and typically involves addressing the underlying cause, along with drainage procedures like thoracentesis or chest tube placement for large or symptomatic effusions 1. The American Thoracic Society guidelines suggest that treatment should aim to relieve dyspnea in a minimally invasive manner and minimize repeated procedures and interaction with the healthcare system. For patients with symptomatic recurrent malignant pleural effusion with documented re-expandable lung, tunneled pleural catheters or chemical pleurodesis are recommended 1.
Key considerations in managing pleural effusions include:
- Addressing the underlying cause of the effusion
- Drainage procedures for large or symptomatic effusions
- Minimally invasive approaches to relieve dyspnea and minimize healthcare system interaction
- Consideration of patient-centered outcomes and quality of life
- The potential need for more invasive interventions if treatment is delayed, such as video-assisted thoracoscopic surgery (VATS) or decortication to free the trapped lung.
In terms of specific management options, thoracoscopy with talc poudrage has a high success rate of 90% 1, but it is an invasive procedure and may not be available in all settings. Other options, such as long-term indwelling catheter drainage and pleuroperitoneal shunt, have their own advantages and disadvantages and should be considered based on individual patient needs and circumstances. Ultimately, the goal of treatment is to improve symptoms, quality of life, and outcomes for patients with pleural effusions, while minimizing morbidity and mortality.
From the Research
Complications of Untreated Pleural Effusion
- If a pleural effusion is left untreated for a long time, it can lead to various complications, including:
- Empyema, which is a collection of pus in the pleural space 2
- Loculated pleural effusion, where the fluid becomes trapped in a specific area of the pleural space 2
- Respiratory failure, due to the accumulation of fluid in the pleural space, which can compress the lung and prevent it from expanding properly 3
- Malignant pleural effusion, which can occur in patients with cancer, and can cause significant morbidity and mortality 4, 5
Symptoms of Untreated Pleural Effusion
- Patients with untreated pleural effusion may experience:
- Dyspnea, or shortness of breath, which can worsen over time 3, 5
- Chest pain, which can be sharp or dull, and may worsen with deep breathing or coughing 3
- Cough, which can be dry or productive, and may worsen over time 3
- Fatigue, which can be due to the decreased oxygenation of the blood and the increased workload on the heart 6
Management of Pleural Effusion
- The management of pleural effusion depends on the underlying cause, and may include:
- Thoracocentesis, which is the removal of fluid from the pleural space using a needle or catheter 3
- Pleurodesis, which is a procedure that involves introducing a substance into the pleural space to cause inflammation and scarring, which can help to prevent further fluid accumulation 4, 5
- Indwelling pleural catheter, which is a small tube that is inserted into the pleural space to allow for repeated drainage of fluid 2, 5
- Surgery, which may be necessary in some cases to remove the pleural effusion or to repair any underlying damage to the lung or pleura 3