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Pleural Effusion

A diagnosis of mesothelioma usually indicates a number of troubling symptoms are being exhibited that can severely affect the patient's quality of life. One of those symptoms is pleural effusion, an accumulation of fluid in the pleural cavity (the space that surrounds the lung). This fluid can make the expansion of the lungs difficult, causing chest pain and a dry cough that makes it difficult to breathe.

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How is it Diagnosed?

Pleural effusion is a very common symptom of mesothelioma and other asbestos-related diseases, especially as the diseases progress. In order to determine whether pleural effusion is present, the doctor will order an imaging test, usually a simple chest x-ray. Effusion will show up on the x-ray once accumulation has reached about 300 milliliters. Prior to that, it may be difficult to spot the fluid on a chest image.

However, there are other signs of pleural effusion that aid in diagnosing the condition. They include diminished breath sounds on the affected side, diminished movement of the chest on the affected side, and decreased vocal resonance. (Some of these symptoms can also indicate the presence of pneumonia and other diseases or disorders, so more tests may be ordered to determine an accurate diagnosis.)

Once the doctor determines that there is indeed fluid in the pleural cavity, a sample may be drawn out for evaluation purposes. Analysis of the fluid can determine whether a bacterial infection is the culprit or whether cancer cells are present. Statistics show that lung cancers (including mesothelioma), breast cancer and lymphoma account for about 75 percent of all malignant pleural effusions.

Treating Pleural Effusion

A patient with pleural effusion due to mesothelioma is generally treated with a procedure known as thoracentesis. This involves the insertion of a thin needle into the pleural space in order to aspirate the fluid. The procedure will make breathing easier and relieve pressure on the lungs. Some patients need to have this procedure repeated again and again to keep the pleural space free of fluid.

During thoracentesis, the patient will be seated upright and an ultrasound may be used in order to find the best place for suctioning the fluid. A local anesthetic is generally used to minimize discomfort. The needle will usually be inserted between the ribs at the back of the chest and will be attached to flexible plastic tubing and a vacuum bottle that collects the fluid. A sterile dressing will be applied after the procedure is complete and another x-ray may be performed to determine its success and assure no complications have risen.

In some cases, a doctor will also recommend a surgery known as pleurodesis. This is a more long-term solution for someone with recurring pleural effusion. The pleurodesis involves the insertion of talc into the pleural cavity. The talc causes irritation between the parietal and the visceral layers of the pleura, closing off the space between them and preventing the further accumulation of fluid. A local or generalized anesthetic is used during the pleurodesis. Though this isn't technically a surgical procedure, it is painful and can require an extended hospital stay if complications arise or if the patient is in overall poor health.

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