What exactly is pleural effusion? Let's find out exactly what it is.

You've probably heard of an elderly person being hospitalized with "fluid in the lungs." Maybe it's happened to someone in your own family. What exactly does this "fluid in the lungs" mean? Is this something to be afraid of? Today, let's talk about this condition, which is called ``Pleural Effusion'' in medical terms, in a very simple way that you can understand.

What exactly does it mean to fill your lungs with water?

Imagine that our lungs are in a protective chamber inside the chest. Around these lungs, as well as on the inside of the chest, are two thin membranes. It's like a balloon inside a balloon. We call these two membranes the pleura.

Normally, in a healthy person, there is a very small amount of fluid between these two membranes. It's like a little grease in a machine. Because of this amount of fluid, when we breathe, when our lungs contract and expand, that process happens without any difficulty or friction. That's the natural way.

But in a condition called ``Pleural effusion'', more fluid than is necessary accumulates in the empty space between these two membranes. This is what we commonly call "fluid in the lungs." To be precise, this fluid does not fill the lungs themselves, but between the two pleural membranes that surround the lungs.

There can be two main reasons for fluid accumulation in this way:

1. The body may be producing too much of this fluid.

2. Otherwise, the body may not be able to properly reabsorb the normal amount of fluid produced.

Either way, the result is that fluid builds up around the lungs, putting pressure on them, and breathing difficulties begin to occur.

There are two types of liquids that come together.

Doctors divide pleural effusion into two main types based on the nature of the fluid that accumulates. Because the components of the fluid can give a good idea of ​​what the cause is.

When treating, it is essential to find out exactly which of these two types you have and what is causing it.

What symptoms might you experience?

Some people have pleural effusion but do not show any symptoms. It is discovered incidentally during a chest X-ray for another reason. However, many people develop symptoms, especially when the fluid builds up.

• Difficulty breathing: This is the main and most common symptom. When fluid fills around the lungs, there is not enough room for the lungs to inflate properly. This makes it difficult to breathe and makes you feel suffocated.
• Chest pain: A sharp pain that is felt especially when taking a deep breath or coughing. This occurs when the two pleural membranes rub together.
• Dry cough: Some people may develop a persistent dry cough.
• Orthopnea: This is a somewhat unique symptom. Breathing becomes more difficult when lying down, but breathing becomes easier when sitting or standing up.
• Fever: If the underlying cause is an infection (such as pneumonia), symptoms such as fever and body aches may also occur.

How to recognize this condition?

When you go to see a doctor, he or she will first ask you about your symptoms and any other medical conditions you may have (such as heart disease or diabetes). Then they will place a stethoscope on your chest and listen. If there is fluid around your lungs, the sounds you hear when you breathe may change.

After that, several tests will be ordered to confirm the disease and find the cause.

• Chest X-ray: This is the most basic and easiest test. The X-ray can clearly see if there is fluid around the lungs and how much there is.
• CT scan: This can produce a clearer, three-dimensional (3D) image of the lungs and pleural space. This can be very helpful in finding the cause of the fluid buildup (such as a tumor).
• Ultrasound scan: This can help pinpoint the location of the fluid and measure the amount of fluid. It is used to help guide the needle into the area, especially when performing a procedure that involves removing fluid.
• Thoracentesis: This is one of the most important tests. It involves making a small incision in the chest, inserting a small needle between two ribs, and taking a sample of the fluid around the lungs. This fluid sample is then sent to a lab for testing.

What do you look for when testing a liquid sample?

The lab tests the fluid for protein, sugar, cell types (are there cancer cells?), and microorganisms like bacteria. This information helps the doctor determine whether it is ``Transudative'' or ``Exudative'', and whether the cause is an infection, cancer, or something else.

In some cases, if these tests cannot pinpoint the cause, a procedure called a thoracoscopy or VATS may be performed. This involves inserting a camera through one or more small incisions in the chest to look directly at the pleura and lungs. A sample of tissue may also be taken for biopsy.

What are the treatments?

There are two main goals in treating pleural effusion:

1. Removing excess fluid and relieving breathing difficulties.

2. Treating the underlying cause of this fluid buildup and preventing further fluid buildup.

1. Treating the underlying cause

• If fluid accumulates due to heart failure , medications that improve heart function and diuretics (water pills) that remove excess water from the body are given.
• If the cause is a bacterial infection like pneumonia , antibiotics are given.
• If the cause is cancer , you will need to undergo chemotherapy and radiation therapy.

2. Methods for removing accumulated fluid

• Therapeutic Thoracentesis: This is the same test we discussed earlier, but instead of taking a sample, as much of the fluid as possible is removed with a needle. This provides immediate relief to the patient.
• Chest Tube: If the amount of fluid is too much or the fluid is thick (like pus), a small tube called a ``chest tube'' may be placed in the chest for a few days. The fluid is slowly drained into a bottle through this tube.
• Pleural Sclerosis: This procedure is used if fluid continues to accumulate due to a cause such as cancer. In this procedure, a special medicine (such as talc) is inserted through a chest tube between the two pleural membranes. This medicine causes inflammation between the two membranes, causing them to stick together. This then eliminates the space where fluid could accumulate again.
• Surgery: If other methods are not successful or if a thick layer has formed around the pleura due to infection, surgery may be necessary.
• VATS (Video-assisted thoracoscopic surgery): A surgery performed using a camera inserted through small incisions.
• Thoracotomy: A traditional surgery that involves opening the chest. This can completely remove infected tissue.

Complications that may arise from this condition

If not treated properly, pleural effusion can cause various complications.

• Infection: Germs can enter the fluid around the lungs and form an abscess.
• Scarring around the lungs: Prolonged fluid retention can cause the pleural membrane to thicken, preventing the lungs from inflating properly.
• Collapsed lung/Pneumothorax: Sometimes the lungs can be damaged during the fluid removal process.

Therefore, it is very important to seek medical advice immediately if you have symptoms.

Can this situation be avoided?

Since pleural effusion is a result of another disease, what we have to do is try to prevent the development of that underlying disease.

• Avoid smoking: Smoking is a major cause of lung cancer and heart disease.
• Avoid exposure to asbestos: This can cause lung diseases.
• A healthy lifestyle: Things like a balanced diet, exercise, and reducing excessive salt intake can help control conditions like heart disease and kidney disease.
• If you already have heart or kidney disease, take the medication exactly as prescribed by your doctor and attend clinics on time.