Exudative pleural effusion is a buildup of protein-rich fluid in the cavity around the lungs, caused by local injuries to the tissue in and around the lungs. The injury causes cells to start leaking fluid, sometimes very rapidly. This contrasts with a transudative pleural effusion, where systemic processes make the vessels more permeable and increase pressure, causing watery fluid to start leaking into the pleural space. Testing can determine what kind of effusion is involved and may also narrow down the cause.
Cancers, trauma, and infections are all possible causes of an exudative pleural effusion. In all of these cases, localized cell damage can force cells to leak proteins and other materials. While the pleural space normally has some fluid to lubricate the lungs, when too much builds up, it is very difficult to breathe. One or both sides of the chest may be involved, and the patient typically develops difficulty breathing, strange breath sounds, and issues like cyanosis, where the extremities start to turn blue as a result of poor oxygenation.
Doctors can insert needles or drains to rapidly relieve the buildup of fluid. Samples of the fluid can be taken to the lab and analyzed to learn more about what is happening inside the body. With an exudative pleural effusion, protein levels in those samples will be high. The balance of proteins and other materials can also provide clues to the cause of the pleural effusion, as can the presence of things like malignant cells or bacteria in the fluid sample. Pathologists have criteria they can use to evaluate samples methodically.
Treatment of an exudative pleural effusion starts with getting rid of the excess fluid so the patient can breathe more easily. Once the patient is stable, evaluation and treatment of the cause can begin. Treatment options can include things like antibiotics to treat infections, as well as therapy to manage cancerous tumors in and around the lungs. A doctor may call in specialists to consult with as more information about the fluid buildup is collected during the process of diagnosis.
People with existing lung disease who notice increased difficulty breathing or crackling, creaking sounds when they breathe should go to a doctor for evaluation. They may have exudative pleural effusion or fluid inside the lungs, and this could compromise their health. When seeking treatment with a new doctor, the doctor should be advised about the history of lung disease, as well as the current course of treatment.