Pleural Effusion and Pleurodesis
The lungs are wrapped in two layers of tissue called the pleura. The outer layer (parietal pleura) lines the chest wall and the inner layer (visceral pleura) covers the lung itself. A thin film of fluid, which enables the layers to slide over each other as you breathe in and out, separates the two layers.
A pleural effusion is a collection of excess fluid in the space between the two layers of pleura. This can compress the lung and may cause shortness of breath.
A pleural effusion usually results from the abnormal accumulation of pleural fluid in the pleural cavity. This accumulation can be either the result of excess production of fluid and/or decreased absorption. There are multiple causes of this condition, including heart failure, kidney disease, liver disease, post-cardiac surgery, infection, and cancer. The diagnosis and treatment involves draining the excess fluid from the pleural space using a chest tube and sending the fluid for analysis.
If the pleural effusion becomes recurrent and symptomatic and if the lung had an adequate lung re-expansion with the previous drainage then a procedure referred as pleurodesis can prevent recurrence.
Pleurodesis causes the two layers of pleura to become inflamed so that when the lung re-expands they stick together and the lung is anchored to the chest wall. This should prevent the fluid from re-accumulating.
Pleurodesis is done by injecting a solution into the pleural space through the chest drain tube or under direct visualization of the pleural space during thoracoscopy. The solution is generally made up of sterile talc (although another drug may sometimes be used instead of sterile talc), normal saline and local anesthetic. If the procedure is done through a chest tube, it will be clamped for 2-4 hours after the injection of the solution. The procedure can cause discomfort and strong painkillers are usually given before it is carried out.
The chest drain will be left in position for a few hours after the procedure and may in some cases be re-attached to suction to help the lung stick against the chest wall. Occasionally fluid may drain from the pleural space for a while after the pleurodesis and the drain will be left in until this stops (this usually takes 3 to 7 days). Once the drain has been removed, the patient is able to go home.
Although pleurodesis is considered a safe procedure, it is not free of complications. Most patients will experience pain and fever. In rare case, severe pneumonitis (inflammation of the lungs) will cause respiratory insufficiency.