Persistent Pleural Effusion: Causes and Concerns

Q: Persistent Pleural Effusion: Causes and Concerns

Hello： It is not possible to determine the cause of your father's pleural effusion based on your description. <br>Please discuss this in detail with your father's attending physician. <br>Thank you. <br>Sincerely, Jian Shun Tian.

Pleural effusion has been persistent?

I consulted with the doctor regarding my father, who had a stent placed on July 17, 2018, and was discharged on July 18.
On July 19, he went to the emergency room for evaluation of pleural effusion, where 400-500 cc of fluid was immediately drained.
He was then admitted for further examination.
During his hospitalization, an ultrasound of the lungs on July 22 revealed more fluid, and an additional 300-400 cc was drained.
On July 27, more fluid was found, and the doctor drained 550 cc.
Blood tests were conducted, including tests for pleural effusion, cancer cell cultures, sputum tests for tuberculosis, and pleural biopsy for extrapulmonary tuberculosis.
X-rays were also performed.
The reports indicated that cancer cell markers were normal, and both pulmonary tuberculosis and extrapulmonary tuberculosis were normal.
Liver and kidney functions were normal, and there was no enlargement of the heart.
The only abnormal finding was a slightly elevated white blood cell count.
The pleural effusion report indicated pneumonia.
During his hospitalization, my father had a fever of 38.2 degrees Celsius on July 20, which decreased to 37.5 degrees on July 21, and remained around 36 degrees from July 22 to 27, with antibiotics administered every 8 hours.
After the pleural effusion was drained on July 27, he was discharged in the evening.
My father has a history of hypertension, peptic ulcer disease, and coronary artery disease.
I asked the attending physician why the reports appeared normal yet he continued to have pleural effusion.
The doctor could not determine the cause and advised us to monitor the situation, prescribing oral antibiotics and scheduling a follow-up appointment.
I would like to ask the doctor why my father continues to experience pleural effusion.

Chen Xiaoyu, 30~39 year old female. Ask Date: 2018/07/27

Dr. Jian Shuntian reply Pulmonology

Hello: It is not possible to determine the cause of your father's pleural effusion based on your description.
Please discuss this in detail with your father's attending physician.
Thank you.
Sincerely, Jian Shun Tian.

Reply Date: 2018/07/27

More Info

Persistent pleural effusion, or the accumulation of fluid in the pleural space surrounding the lungs, can be a complex condition with various underlying causes. In your father's case, the presence of pleural effusion following his stent placement raises several considerations that need to be addressed.

Causes of Persistent Pleural Effusion
1. Post-Operative Complications: After procedures like stent placement, fluid accumulation can occur due to surgical trauma or inflammation. This is often a transient condition, but it can lead to persistent effusion if not resolved.

2. Infection: Your father's elevated white blood cell count and fever suggest a possible infectious process, such as pneumonia or empyema (infected pleural effusion). The presence of pneumonia, as indicated in the reports, could lead to fluid accumulation as the body responds to infection.

3. Malignancy: While your father's cancer markers were normal, malignancy remains a common cause of pleural effusion. It’s important to continue monitoring for any signs of cancer, especially if there are risk factors present.

4. Heart Failure: Although your father's heart function was reported as normal, heart failure can lead to fluid accumulation in the pleural space. This is often due to increased pressure in the blood vessels, causing fluid to leak into the pleural cavity.

5. Liver or Kidney Issues: While liver and kidney functions were reported as normal, any underlying chronic conditions could contribute to fluid retention and effusion.

6. Tuberculosis: Although tests for pulmonary and extrapulmonary tuberculosis were normal, it is worth noting that TB can cause pleural effusion, and further evaluation may be warranted if symptoms persist.

Concerns and Management
Given the complexity of your father's condition, it is essential to continue monitoring and follow-up care. Here are some considerations:
- Regular Follow-Up: Ensure that your father has regular follow-up appointments with his healthcare provider to monitor his condition and any changes in symptoms.

- Symptom Management: If your father experiences symptoms such as shortness of breath, chest pain, or fever, it is crucial to seek immediate medical attention.

- Further Testing: If the pleural effusion persists, further diagnostic tests may be necessary, including repeat imaging studies or additional thoracentesis (the procedure to remove fluid) to analyze the fluid for specific causes.

- Medication Adherence: Ensure that your father adheres to the prescribed antibiotic regimen and any other medications to manage his underlying conditions, such as hypertension and coronary artery disease.

- Lifestyle Modifications: Encourage a heart-healthy diet, regular physical activity as tolerated, and adherence to any dietary restrictions related to his medical history.

Conclusion
Persistent pleural effusion can be indicative of various underlying conditions, and in your father's case, it may be related to post-operative changes, infection, or other systemic issues. Continuous monitoring, appropriate management of underlying conditions, and open communication with healthcare providers are essential for addressing this complex issue. If symptoms worsen or new symptoms arise, do not hesitate to seek immediate medical attention.

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