Pleural effusion is a buildup of fluid in the pleural space, between the lung and the chest wall. It becomes trapped due to adhesions or scar tissue, making it harder to drain. Causes include pneumonia, infections, hemorrhage, malignancy, previous pleural interventions, complicated parapneumonic effusion, tuberculosis, cancers, empyema, or trauma. The most common symptoms of a fluid-restricted lung effusion include shortness of breath, chest pain, cough, and fever, which can be sharp, pleuritic, dry, or productive and may be due to an infection causing the effusion. Diagnosis involves chest X-ray, CT scan, ultrasound, and pleural fluid analysis. A chest X-ray can show the presence of a pleural effusion but may not clearly demonstrate loculations. CT scans can visualize fluid collections and surrounding lung tissue, while ultrasound can detect loculations and guide drainage procedures. Pleural fluid analysis can help determine the cause of the effusion, such as infection or malignancy.
Treatment depends on the size and complexity of the effusion, the patient’s health, and the underlying cause. Non-surgical management includes image-guided drainage and fibrinolytic therapy. Whereas surgeries include video-assisted thoracoscopic surgery (VATS) and open thoracotomy. VATS involves small incisions in the chest wall and a camera to drain fluid effectively. Open thoracotomy may be necessary for extensive adhesions or a thick peel surrounding the lung. Decortication may be performed during VATS or open thoracotomy to allow the lung to re-expand fully. Antibiotics are administered if the effusion is due to an infection.
Mr. J. B. Patil from Hyderabad successfully underwent VATS Lung Decortication for Multiloculated Pleural Effusion at Yashoda Hospitals, Hyderabad, under the supervision of Dr. Manjunath Bale, Consultant Robotic and Minimally Invasive Thoracic Surgeon.