What is Pleural Effusion?


Pleural Effusion translates to the collection of fluid in the space between the lungs and a chest cavity as a result of diseases that restrict lung expansion. Between the lung and the chest cavity is a thin space containing fluid similar to interstitial fluid produced by capillaries in the surrounding tissue. It usually averages about 30ml. This acts as a lubricant between the lungs and the chest cavity during mechanical processes such as breathing. This fluid is usually drained by lymphatic capillaries to ensure that it does not collect and put pressure on the lungs. The only way through which pleural effusion can be resolved is through Pleural Effusion treatment in Singapore by an experienced specialist who treats patients with lung-related diseases.

There are essentially three types of pleural effusion. Transudative and Exudative Effusion where too much fluid is produced or lymphatic effusion where the lymphatic vessels are not able to efficiently drain the fluid.

Causes of Pleural Effusion

Transudative effusion happens when too much fluid leaves the capillaries either due to increased blood pressure. Conditions that cause such an event are:

  • Heart Failure
  • Pulmonary embolism
  • Cirrhosis
  • Post open heart surgery

Exudative effusion happens when large molecules are unable to pass in through the walls of the capillaries. This causes water molecules to move out of the capillaries through a process known as osmosis. Conditions that can cause this are:

  • Pneumonia
  • Cancer
  • Pulmonary embolism
  • Kidney disease
  • Inflammatory disease
  • Tuberculosis
  • Autoimmune disease

A lymphatic effusion occurs when lymphatic vessels are unable to drain the fluid properly thus leading to it collecting in the lungs. Some causes include:

  • Damage to the thoracic duct
  • Tumours that press against the thoracic duct

Symptoms of Pleural Effusion

Symptoms are highly dependent on the severity of the effusion. A small effusion would go mostly unnoticed while a larger effusion may cause significant pain and discomfort which can be resolved only through proper Pleural Effusion treatment in Singapore. Some of the symptoms include:

  • Chest pain
  • Dry and non-productive cough
  • Dyspnea: Shortness of breath, or difficult, laboured breathing
  • Orthopnea: The inability to breathe easily unless the person is sitting up straight or standing erect



The surgeon will carefully insert a needle on top of a rib to drain the fluid. This will help relieve the symptoms and give him a good understanding of the main cause of the pleural effusion.

The different appearance of the fluids will help the surgeon categorise which type of pleural effusion the patient is suffering from.

Tranudative fluid: Clear

Exudative Fluid: Contains immune cells thus looks cloudy.

Lymphatic fluid is filled with fats and gives a milky appearance.


Chest X-ray, CT scan and Ultrasounds can help further support the diagnosis and also allow the doctor to tell if there are any other diseases within the lungs such as tumours.


Treatment methods are highly dependent on the underlying health condition causing the effusion along, and if the effusion is causing severe respiratory symptoms such as shortness of breath and/ or difficulty breathing.

If the underlying health condition is heart failure, diuretics and other heart failure medication will be used to treat the symptoms. A malignant effusion caused by cancer cells may require radiation therapy and chemotherapy to solve the problem. If the precipitating factor is due to respiratory issues, the above-mentioned thoracentesis or thoracostomy (by use of a chest tube) can be used to drain the fluid.


There are two approaches to surgery.

The first is video-assisted thoracic surgery. This will occur via 2-3 keyhole incisions in the chest followed by the draining of fluid. In some cases, a biopsy or pleurodesis is required and is achieved using talc powder. Lastly, a chest tube is placed in the incisions to drain the fluid.
The second is a 
traditional thoracotomy where the incision is made across the chest wall. This is done in cases of serious infections or post-radiation adhesions. This will be followed by the insertion of chest tubes to allow the drainage of fluid.

At ICTS, minimally invasive procedures are preferred. However, all options will be discussed with the patient during the consultation.

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