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Shortness of Breath - Pleural Effusion

This is an accumulation of fluid produced by the mesothelioma tumour in the space between the two layers of the pleural membrane. The majority of people with pleural mesothelioma develop pleural effusions, particularly in the early stage of the disease. Large effusions, particularly if they develop rapidly, may cause severe shortness of breath.

The effusion is confirmed by chest x-ray and the immediate treatment is drainage (‘aspiration’, ‘pleural tap’ or ‘thoracocentesis’) in hospital with rapid relief of breathlessness. In some cases the drainage tube is left in place for a few days to ensure all the fluid is removed. Unfortunately pleural effusions often recur and can become increasingly difficult to drain because the fluid tends to form in pockets (ie becomes ‘loculated’) or becomes very sticky.

Illustrated image of Lungs with pleural effusion
Illustrated image of Lung with pleural effusion

In order to prevent recurrent effusions the procedure of pleurodesis is performed. Pleurodesis is a method of making the two layers of the pleural membrane stick together which obliterates the space between them thus preventing the formation of further effusions. The procedure involves introducing an irritant material, usually sterile talc, via a tube (either a chest drain or thoracoscope) into the space between the pleural layers (any fluid has to be drained first). This is sometimes aided by video-camera viewing of the inside of the chest – a VATS (video-assisted thoracoscopy) procedure. Pleurodesis tends to be successful in most cases, particularly if performed early on in the disease.

Managing pleural effusions with a tunnelled indwelling catheter (TIPC) is becoming more common, this can be useful when fluid can't be managed by other means, this involves having a tube inserted into the pleural space which exits out of the skin.  The tube is neatly secured under a dressing until needed and when fluid needs to be drained it can be uncovered and connected to a drainage bottle which contains a vacuum.  Before this technique was developed patients often had repeated trips to the hospital to have fluid drained away to relieve breathlessness, having a TIPC means fluid can be easily drained off at home either by the community nurses or sometimes patients and their relatives learn to do this. Click here to download a booklet providing further information on pleural effusion.