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Thread: Pleural Effusion

  1. #1
    AllForDad Guest

    Default Pleural Effusion

    Hello again,

    My father just went for his one week discharge checkup with his cardiologist and it was found that he has a pleural effusion, which explains the slight difficulty in breathing he was having while lying down.....what I was afraid of.

    Right now he is getting a chest xray to see the extent of it. My guess is that the effusion is small, being that he has no pain, can walk miles with no problem, and really only feel it when he is talking on the phone and breathing, or lying down flat.

    Anyone who has experience with this could you tell me what the next step is? Also, once fluid is drained or the effusion is taken care of, is that the end of it or is there a big chance of its return?

    I'm hoping this effusion is also the reason for his slight temps... about 100.5 which come and go. They drew blood to make sure. Anyone have temps along with their effusion?

    Thanks!
    AllForDad

  2. #2
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    If it's very mild, it may resolve on it's own accord, but should it step up production and he really is feeling pain and major shortness of breath, they'll aspirate the fluid with a syringe in the Doctors office. Most likely they'll give him some steroids for now and monitor him closely. Effusion can come back, so it's important to treat the cause of inflammation, which is what the steroids will be for. The fever thing is something most all of us went through. It should disappear soon on it's own.

  3. #3
    AllForDad Guest

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    Didn't someone mention in another thread that their surgeon said that steriod treatment is not a good route?

  4. #4
    Karlynn Guest

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    I believe that was Davidfortune that posted something regarding steroids and his pleural effusion.

    Best wishes to your Dad!

  5. #5
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    Quote Originally Posted by AllForDad
    Didn't someone mention in another thread that their surgeon said that steriod treatment is not a good route?
    In my opinion, steriods for anything is no good, but when it comes to inflamation of lung lining, it's the drug of choice.

  6. #6
    AllForDad Guest

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    Alright... I'll keep researching. Anyone else with pleural effusion experience?

  7. #7
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    Originally posted by AllForDad
    Didn't someone mention in another thread that their surgeon said that steriod treatment is not a good route?
    Perhaps you are referring a something I posted to the tread entitled "post op pericardial effusion" started by Bridgette about my experience with Pericardial Tamponade....

    I had a bad experience with steroids.

    After I saw the GP, who could barely find my pulse, I went straight to the ER at the local hospital where I was admitted. It was a Friday and unfortunately my regular Card was out of town so the ER Card looked after me. He tried draining with the needle but that didn't work so he tried steroids. I ended up getting sicker and started throwing up. After a really bad weekend, on Monday my regular Card was back and he immediately called my Cardiac Surgeon, Dr. David, in Toronto. I then got my first ambulance ride (red lights and everything!) to Toronto and straight into OR, put under, and got drained surgerically. Drain tube left in a few days and was finally discharged the following Saturday. Anyway, Dr. David's associate told me if anyone tried to give me steroids again, don't let them. I was prescribed Colchicine, which is actually a med for gout but apparently has proven to prevent effusion, for 3 months. It never reocurred.
    Wayne
    02/28/06 Mitral Valve Repair & closure of atrial septal defect - Dr. Tirone David
    03/24/06 Pericardial Tamponade

  8. #8
    AllForDad Guest

    Default

    Well, my dad visited the cardio and had a chest xray, blood drawn, etc.

    All was sent to the surgeon.

    White count was normal, but xray revealed fluid.

    This morning he woke up with temp of 101.9, highest it's been, but went away with tylenol. Went back to the hospital and is being admitted back under Dr. Coselli's service (the surgeon). Waiting for an echo to reveal exactly how much fluid is there and if it needs to be evacuated. I just hope the fever is nothing. His white count is normal, so we'll see.

  9. #9
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    Hopefully they can just give him some diuretics and let that take care of it.

  10. #10
    AllForDad Guest

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    I don't believe diuretics pull fluid from the pleural space. Unless by dehydrating the rest of the body the pleural fluid is readily absorbed. I work cardiothoracic ICU and I've never seen diuretics given for a pleural effusion.... interesting....

  11. #11
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    At my two week follow up they detected left pleural effusion up to my collar bone. They made immediate decision to drain, so called thoracentesis. My surgeon asigned one of his NP's, a man, to do it. He said this fellow was better at it than he was. I hardly felt the needle stick but over the next hour the NP withdrew five pints of bright red blood with a big syringe.I immediately could breathe better and no longer had the heavy feeling in my side. The effusion in my case never recurred. Later I asked my cardiologist how serious he thought this was. He said "it happens all the time", "don't worry". I hope your Dad has the same result.
    Marty
    Mitral valve replacement
    September 17, 1998
    Mechanical St. Jude
    Inova Fairfax, Falls Church VA
    Dr. Ed Lefrak

  12. #12
    Susan BAV Guest

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    No experience with it but wanted to tell you I'm hoping things go well for your dad. Take care and tell him hi from the VR.COM folks.

  13. #13
    AllForDad Guest

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    Quote Originally Posted by Marty
    At my two week follow up they detected left pleural effusion up to my collar bone. They made immediate decision to drain, so called thoracentesis. My surgeon asigned one of his NP's, a man, to do it. He said this fellow was better at it than he was. I hardly felt the needle stick but over the next hour the NP withdrew five pints of bright red blood with a big syringe.I immediately could breathe better and no longer had the heavy feeling in my side. The effusion in my case never recurred. Later I asked my cardiologist how serious he thought this was. He said "it happens all the time", "don't worry". I hope your Dad has the same result.

    Marty,

    The fluid that had collected in your pleural space was actually blood?? Not fluid which was kinda clear redish/yellow?

  14. #14
    Susan BAV Guest

    Default From Healthtouch.com

    PLEURAL EFFUSION

    GENERAL INFORMATION:
    What is pleural effusion? The pleura (PLOOR-ah) are thin layers of tissue that form a two-layered lining around the lungs. One layer of the pleura rests directly on the lungs. The other layer rests on the chest wall. Between these layers there is a small amount of fluid, called pleural (PLOO-ral) fluid. This fluid helps your lungs move easily when you breathe. Sometimes extra fluid collects in the space between the two pleural layers. This is called pleural effusion (e-FU-zhun).

    What causes pleural effusion? Many different things can cause pleural effusion. Heart failure or other heart and lung problems may cause pleural effusion. Infections (in-FECK-shuns) such as pneumonia (noo-MOH-nyah) or tuberculosis (TB) may cause pleural effusion. Inflammation of the pleura, called pleurisy (PLOOR-i-see), may cause pleural effusion. Other causes may include cancer, injury, or problems with other organs in your chest or abdomen (belly).

    What are the signs and symptoms of pleural effusion? A pleural effusion may cause you to cough or feel short of breath. You may breathe faster than usual. You may have chest pain that starts or gets worse when you breathe in. The pain may hurt the most when you take a deep breath or cough. The pain can range from mild to severe (very bad). Depending on the cause of your pleural effusion, you may have other symptoms, such as a fever. You may have no symptoms at all.

    How is pleural effusion diagnosed? Your caregiver will examine you and listen to your heart and lungs through a stethoscope (STETH-oh-skohp). You may need blood tests, a chest x-ray, a CT ("cat") scan, or an ultrasound of the chest. Ask your caregiver for more information about other tests that you may need.

    How is pleural effusion treated?
    The treatment you receive may depend on what is causing your pleural effusion and how bad your symptoms are. You may need medicines such as antibiotics (an-ti-bi-AH-tiks) to prevent or treat a bacterial (bak-TEE-ree-al) infection. Steroids and other kinds of medicines may be given to decrease inflammation. You may need medicines for pain. Diuretic (deye-yoo-RET-ik) medicine may help you lose extra fluid caused by heart failure or other problems. You may need to have the extra pleural fluid removed by having a thoracentesis (thohr-ah-sen-TEE-sis) or a chest tube. During a thoracentesis, a needle is used to remove the extra pleural fluid from around a lung. This fluid may be sent to the lab for tests. A thoracentesis may help you breathe easier, and help your caregiver find the best way to treat you. A chest tube is a tube that stays in your chest for days or weeks. This lets the extra fluid around your lung drain out over time. You may need medicines put directly into your chest if the fluid does not drain out easily.

    Some people have pleural effusions that come back over and over. For example, a tumor (growth) may cause extra fluid to keep collecting around a lung. If your pleural effusion keeps coming back or if it increases your risk for other problems, you may need surgery or other treatments. Ask your caregiver for more information about other treatments that you may need.

    Risks: A pleural effusion may cause or worsen a lung infection, such as pneumonia. The extra fluid may get infected and form a pocket of pus, which is called empyema (em-peye-EE-ma). You may have other problems, such as a collapsed lung. The problems you may have depend on what is causing your pleural effusion. Talk to your caregiver about any concerns you may have about your illness or treatment.

    For more information: Contact the following for more information about pleural effusion and other lung problems:

    American Lung Association
    61 Broadway, 6th floor
    New York City, NY 10006
    Phone: 1-800-586-4872
    Web Address: http://www.lungusa.org

    Centers for Disease Control and Prevention
    1600 Clifton Road
    Atlanta, GA 30333
    Phone: 1-404-6393311
    Phone: 1-800-3113435
    Web Address: http://www.cdc.gov

    -------

    I don't know if this is helpful.

    I also found some information on a pdf but it was a study about TB:
    http://www.mrc.ac.za/cochrane/fleishman.pdf
    "Adjunctive steroid therapy appears to be an effective treatment for reducing residual pleural fluid in patients with pleural effusion of unknown cause."

  15. #15
    AllForDad Guest

    Default

    Thanks Susan,

    I had read a lot about it also, and talked to the PAs, NPs, and surgeons I work with. I understand diuretics for heart failure (used all the time), but not for a pleural effusion purely caused by inflammation.

    My dad is actually leaving the hospital in a couple minutes so I will let you all know what happened after my mom calls. I'm guessing nothing serious since he was admitted and discharged in a matter of 4 hours.

    Thanks again!

  16. #16
    AllForDad Guest

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    Ok nevermind... my mom is leaving.

    He is staying the night and tomorrow they are going to put in a small chest tube and drain the fluid. They will then test it for bacteria, possibly causing the fevers.

    I'll update again tomorrow.

  17. #17
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    Quote Originally Posted by AllForDad
    I don't believe diuretics pull fluid from the pleural space. Unless by dehydrating the rest of the body the pleural fluid is readily absorbed. I work cardiothoracic ICU and I've never seen diuretics given for a pleural effusion.... interesting....
    You know, after I posted that, I sat and thought about it. Your right, I'm wrong. Diuretics won't work for effusion.

  18. #18
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    Originally posted by AllForDad
    they are going to put in a small chest tube and drain the fluid. They will then test it for bacteria, possibly causing the fevers.
    That's what they did for me when they treated me for Pericardial Tamponade. They left the drain tube in a couple of days and I stayed in the hospital until the culture results cleared me. I was discharged on diuretics for a small residual pleural effusion. It was completely cleared in about two weeks. As mentioned earlier, I was prescribed Colchicine as a prevention measure for three months, and it did not reoccur.
    Wayne
    02/28/06 Mitral Valve Repair & closure of atrial septal defect - Dr. Tirone David
    03/24/06 Pericardial Tamponade

  19. #19
    bulldog Guest

    Default

    Quote Originally Posted by Susan BAV
    PLEURAL EFFUSION

    GENERAL INFORMATION:
    What is pleural effusion? The pleura (PLOOR-ah) are thin layers of tissue that form a two-layered lining around the lungs. One layer of the pleura rests directly on the lungs. The other layer rests on the chest wall. Between these layers there is a small amount of fluid, called pleural (PLOO-ral) fluid. This fluid helps your lungs move easily when you breathe. Sometimes extra fluid collects in the space between the two pleural layers. This is called pleural effusion (e-FU-zhun).

    What causes pleural effusion? Many different things can cause pleural effusion. Heart failure or other heart and lung problems may cause pleural effusion. Infections (in-FECK-shuns) such as pneumonia (noo-MOH-nyah) or tuberculosis (TB) may cause pleural effusion. Inflammation of the pleura, called pleurisy (PLOOR-i-see), may cause pleural effusion. Other causes may include cancer, injury, or problems with other organs in your chest or abdomen (belly).

    What are the signs and symptoms of pleural effusion? A pleural effusion may cause you to cough or feel short of breath. You may breathe faster than usual. You may have chest pain that starts or gets worse when you breathe in. The pain may hurt the most when you take a deep breath or cough. The pain can range from mild to severe (very bad). Depending on the cause of your pleural effusion, you may have other symptoms, such as a fever. You may have no symptoms at all.

    How is pleural effusion diagnosed? Your caregiver will examine you and listen to your heart and lungs through a stethoscope (STETH-oh-skohp). You may need blood tests, a chest x-ray, a CT ("cat") scan, or an ultrasound of the chest. Ask your caregiver for more information about other tests that you may need.

    How is pleural effusion treated?
    The treatment you receive may depend on what is causing your pleural effusion and how bad your symptoms are. You may need medicines such as antibiotics (an-ti-bi-AH-tiks) to prevent or treat a bacterial (bak-TEE-ree-al) infection. Steroids and other kinds of medicines may be given to decrease inflammation. You may need medicines for pain. Diuretic (deye-yoo-RET-ik) medicine may help you lose extra fluid caused by heart failure or other problems. You may need to have the extra pleural fluid removed by having a thoracentesis (thohr-ah-sen-TEE-sis) or a chest tube. During a thoracentesis, a needle is used to remove the extra pleural fluid from around a lung. This fluid may be sent to the lab for tests. A thoracentesis may help you breathe easier, and help your caregiver find the best way to treat you. A chest tube is a tube that stays in your chest for days or weeks. This lets the extra fluid around your lung drain out over time. You may need medicines put directly into your chest if the fluid does not drain out easily.

    Some people have pleural effusions that come back over and over. For example, a tumor (growth) may cause extra fluid to keep collecting around a lung. If your pleural effusion keeps coming back or if it increases your risk for other problems, you may need surgery or other treatments. Ask your caregiver for more information about other treatments that you may need.

    Risks: A pleural effusion may cause or worsen a lung infection, such as pneumonia. The extra fluid may get infected and form a pocket of pus, which is called empyema (em-peye-EE-ma). You may have other problems, such as a collapsed lung. The problems you may have depend on what is causing your pleural effusion. Talk to your caregiver about any concerns you may have about your illness or treatment.

    For more information: Contact the following for more information about pleural effusion and other lung problems:

    American Lung Association
    61 Broadway, 6th floor
    New York City, NY 10006
    Phone: 1-800-586-4872
    Web Address: http://www.lungusa.org

    Centers for Disease Control and Prevention
    1600 Clifton Road
    Atlanta, GA 30333
    Phone: 1-404-6393311
    Phone: 1-800-3113435
    Web Address: http://www.cdc.gov

    -------

    I don't know if this is helpful.

    I also found some information on a pdf but it was a study about TB:
    http://www.mrc.ac.za/cochrane/fleishman.pdf
    "Adjunctive steroid therapy appears to be an effective treatment for reducing residual pleural fluid in patients with pleural effusion of unknown cause."
    Thank you for posting this I was just going to ask what it was. I hope its nothing I have to look forward to. thanks again Bulldog

  20. #20
    bulldog Guest

    Default What Is It

    Quote Originally Posted by WayneGM
    That's what they did for me when they treated me for Pericardial Tamponade. They left the drain tube in a couple of days and I stayed in the hospital until the culture results cleared me. I was discharged on diuretics for a small residual pleural effusion. It was completely cleared in about two weeks. As mentioned earlier, I was prescribed Colchicine as a prevention measure for three months, and it did not reoccur.
    What is Pericardial Tamponade if you don't mind me asking?

  21. #21
    Susan BAV Guest

    Default

    Quote Originally Posted by bulldog
    What is Pericardial Tamponade if you don't mind me asking?
    BulldogBob, I looked this up for you: "Pericardial tamponade: A life-threatening situation in which there is such a large amount of fluid (usually blood) inside the pericardial sac around the heart that it interferes with the performance of the heart. The end result, if untreated, is low blood pressure, shock and death. The excess fluid in the pericardial sac acts to compress and constrict the heart. The word "tamponade" is direct from the French. The French verb "tamponner" means to plug up and, also, to smash into. Here the outpouring of fluid within the pericardial sac is, so to speak, smashing into the heart. Pericardial tamponade can be due to excessive pericardial fluid, a wound to the heart, or rupture of the heart. Also called cardiac tamponade."

  22. #22
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    I couldn't have said it better myself

    In terms of why I got it, the way my Card described it apparently in some people (I believe he said 1 in 10,000 but don't quote me), the body reacted to the invasive OHS by producing fluid as a counter measure. In my case I didn't catch it until I reached Pericardial Tamponade status. I felt like crap so went to the GP who could barely find a pulse. Into emergency I went and ultimately into surgery to correct. This was 3 weeks post-op. It can reoccur so I was monitored closely for weeks and took the Colchicine as a precaution. Luckily it did not reoccur. I thought this experience was actually more frightening to go through than the OHS itself.
    Wayne
    02/28/06 Mitral Valve Repair & closure of atrial septal defect - Dr. Tirone David
    03/24/06 Pericardial Tamponade

  23. #23
    Susan BAV Guest

    Default

    Wow, Wayne - Evidently they didn't exaggerate when "life-threatening" was the first description! Have you written your story down for the Story Section here? Glad the thing didn't come back on you!

  24. #24
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    Quote Originally Posted by AllForDad
    Marty,

    The fluid that had collected in your pleural space was actually blood?? Not fluid which was kinda clear redish/yellow?
    Yes, I think it was blood or mostly blood. I never got a good explanation as to what caused it but I believe it was due to a bleeder that was not tied off or zitzed at the surgery along with the fact that my INR was over 5 at the time.Ther was no sign of infection. In your Dad's case they need to make a decision as to do a diagnostic tap and find out the exact composition of the effusion. A lot depends on how large the effusion is. If it is quite small they may simple use diuretics, maybe antibiotics, and hope for spontaneous resolution. Let us know how it goes.
    Marty
    Mitral valve replacement
    September 17, 1998
    Mechanical St. Jude
    Inova Fairfax, Falls Church VA
    Dr. Ed Lefrak

  25. #25
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    Quote Originally Posted by Ross
    You know, after I posted that, I sat and thought about it. Your right, I'm wrong. Diuretics won't work for effusion.
    Ross, In some cases our surgeons DO use diuretics for small non-infectious effusions that don't require thoracentesis. Later their X-rays show the fluid is gone.
    Marty
    Mitral valve replacement
    September 17, 1998
    Mechanical St. Jude
    Inova Fairfax, Falls Church VA
    Dr. Ed Lefrak

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