Mesothelioma Pleural Effusion

What Is Pleural Effusion?

The human body consists of a thin layer of tissue and fluid that lines the lungs and chest cavity. This thin layer is called the pleura, also called the pleural cavity. The pleura’s role is to offer a buffer for the lungs to expand as needed against the chest wall.

The pleura consists of two tissue linings with two sides: one against the surface of the lungs and the other against the chest wall. Between these two tissue linings is a thin space consisting of fluid. A pleural effusion – also called “fluid around the lungs” or “water on the lungs” – is an abnormal collection of fluid in this thin space between the pleura linings.

Approximately 1.5 million people in the United States are diagnosed with pleural effusion each year. It’s a common health condition and has a wide range of potential causes. Around 100,000 cases of pleural effusion are due to cancers such as malignant pleural mesothelioma.

There are two types of pleural effusion. They differ in how they are caused:

• The first type is called transudative pleural effusion. It’s caused by fluid leaking into the pleural space, which leads to more pleural fluid that there should be. This type is most often due to heart conditions.
• The second type is called exudative pleural effusion. This is caused by blocked blood vessels or lymph vessels, inflammation, infection or tumors.

Determining the type of pleural effusion can help doctors narrow down the potential causes.

What Causes Mesothelioma Pleural Effusion?

Mesothelioma pleural effusion is an example of exudative pleural effusion. Pleural mesothelioma tumors can shrink the space in the pleural cavity, which leads to less space for pleural fluid. The result is pockets of pleural fluid pressing against the chest wall and lungs. These pockets of pleural fluid are called malignant mesothelioma pleural effusion.

Mesothelioma also causes pleural effusion by:

• Forming new blood vessels that leak fluid into the pleural space
• Blocking the lymphatic system from draining fluid out of the pleura

The color of mesothelioma pleural effusion can look clear, cloudy, bloody, or black. Many medical sources say it looks bloody or black.

What Else Causes Pleural Effusion?

Pleural effusion is a symptom of pleural mesothelioma cancer, but they are not always cancerous. Pleural effusion can be caused by pleural thickening, which is scarring of the tissue in the pleura. Pleural thickening can be caused by asbestos exposure (which causes mesothelioma) or an infection, meaning it can be cancerous or benign (noncancerous).

Another cause of pleural effusion is lung cancer. According to a 2019 study, lung cancer is the most common cause of pleural effusion.

Other causes of pleural effusion include:

• Pneumonia
• Heart disease
• Liver disease
• Kidney disease
• Pulmonary embolism (Blood clot stuck in an artery of the lungs)

If you’re experiencing pleural effusion – usually manifesting as chest pain or shortness of breath – then talk with your doctor. You’ll likely undergo tests to determine what is causing your pleural effusion.

Symptoms of Mesothelioma Pleural Effusion

Pleural effusion leads to a buildup of pleural fluid, which can cause pressure against the chest wall and lungs. This can lead to chest pain, which is the main symptom of mesothelioma pleural effusion.

Another symptom is difficulty breathing. Mesothelioma pleural effusion causes less buffer space for the lungs to expand, which leads to shortness of breath or rapid breathing.

Other common symptoms of pleural effusion include:

• Dry cough
• Fever and chills
• Hiccups
• Orthopnea (inability to breathe easily unless sitting upright or standing)

How to Diagnose Mesothelioma Pleural Effusion

Symptoms are not enough to diagnose pleural effusion. The best way to medically confirm if you or someone else has pleural effusion is through imaging tests.

The first imaging test is usually a chest X-ray. The second test is a chest CT scan, which provides detailed two-dimensional images. If pleural effusions exist, they will appear on scans as a large mass near your lungs.

Another way to diagnose pleural effusion is with an ultrasound of the chest. Your doctor may also use a stethoscope to listen to your lungs and tap your chest and upper back. Diagnosing pleural effusion can be part of the process for diagnosing pleural mesothelioma.

Testing Pleural Effusion for Mesothelioma

The only definitive way to diagnose pleural mesothelioma is through a tissue biopsy. However, some doctors may test pleural fluid for the presence of cancer cells before recommending a biopsy. This is called mesothelioma pleural effusion cytology, or mesothelioma pleural fluid analysis.

If the pleural effusions are caused by pleural mesothelioma, then doctors can remove samples of the excess pleural effusion to test for mesothelioma cancer cells. Pleural fluid tests are done by removing fluid samples with a needle inserted between the ribs.

According to a 2019 study, approximately 60% of cancer cases can be diagnosed by testing pleural effusion fluid.

Treatment of Mesothelioma Pleural Effusion

Treatment for pleural effusion involves draining the excess fluid from the pleural space. This is done through low-invasive surgeries.

Thoracentesis for Pleural Effusion

The main way to treat pleural effusion is a thoracentesis. This minimally invasive procedure can be used to either diagnose the cause of pleural effusion or remove the excess fluid from the pleural space, or the gap between the two pleural tissue linings. Thoracentesis is a temporary way of treating pleural effusion, because it drains the fluid but does not eliminate the chance of more fluid building up later.

Doctors insert a needle between your ribs and into the pleural space to remove the excess fluid. If there is a large amount of pleural effusion, then the medical team may attach tubing to the needle to drain fluid quicker. In some cases, doctors may use a catheter instead of the needle, and the tubing and catheter will continue to drain the fluid for a day or two.

Thoracentesis to remove malignant mesothelioma pleural effusion can be referred to as a palliative mesothelioma treatment. It reduces symptoms of pleural effusion and mesothelioma in an effort to improve the patient’s quality of life.

Pleurodesis for Pleural Effusion

Pleurodesis is another minimally invasive surgery to treat pleural effusion. Pleurodesis is palliative treatment for pleural mesothelioma. Doctors remove the fluid from the pleura and seal the pleural cavity to prevent future effusions. The doctors use an adhesive to connect the two tissue linings of the pleura. This is a permanent solution to pleural effusion.

While pleurodesis can prevent the occurrence of pleural effusions, it may limit certain surgical treatment options.

Pleurectomy/Decortication

Pleurectomy with decortication surgery removes the pleura, which could eliminate the chance of pleural effusions occurring again. Pleurectomy/decortication is one of the main surgeries for pleural mesothelioma. It’s a way of removing pleural mesothelioma tumors and cancer cells in the chest cavity. This is a permanent solution to pleural effusion.

Extrapleural Pneumonectomy

Extrapleural pneumonectomy surgery removes the pleura, plus the affected lung. This is another surgery for pleural mesothelioma to remove tumors in the chest cavity. Removing the pleura eliminates the possibility of pleural effusions occurring again.