Malignant pleural eIIusion is a condition in which cancer causes an abnormal amount oI Iluid to

collect between the thin layers oI tissue lining the outside oI the lung and the wall oI the chest
cavity. It can occur as a result oI many diIIerent types oI malignancy and indicates that the
cancer has spread to the area around the lung. In an individual with a prior history oI breast
cancer, metastatic recurrence oI breast cancer would be the most common cause oI a malignant
eIIusion. Pleural eIIusion restricts ventilation and causes progressive shortness oI breath.
Normally, very small amounts oI pleural Iluid are present in the pleural spaces, and Iluid is not
detectable by routine methods. When certain disorders occur, excessive pleural Iluid may
accumulate and cause pulmonary signs and symptoms. Normal human beings have the capacity
oI 20-25ml oI Iluids in each pleural space. Fluids enter the pleural space via the capillaries in the
parietal pleura or through the peritoneal cavity through small holes in the diaphragm. Excess
Iluids that have not been absorbed are normally removed by lymphatics in the parietal pleura that
have the capacity to absorb upto 20 times more Iluid than is produced. When this capacity is
overwhelmed, pleural eIIusions develops
Pressure on the chest, chest pain, dyspnea (diIIiculty breathing) and excessive cough are some oI
the common symptoms oI pleural eIIusions. Excessive pleural Iluids can cause intense
inIlammation oI the pleural surIaces and acute pain Ior the patient. II the pleural eIIusions is
between the 500-1500 ml range, this causes chest pressure. II the eIIusions is greater than 1500
ml, this can cause dyspnea which is a diIIiculty in breathing. Dyspnea rarely occurs when the
Iluid in the pleura is low, thus a diIIiculty in breathing signals doctors that there are excess Iluids
in the lungs. Dyspnea occurs not only when the patient is active such as running or jogging, but it
can also occur when the patient is relaxing or sleeping.
Pleural eIIusions are classiIied as transudative or exudative. Most oIten transudative are caused
by congestive heart Iailure, cirrhosis, nephritic syndrome, or occasionally by lymphatic blockade
produced by cancer. Exudative eIIusions are caused by inIection or malignancy. In the absence
oI inIection, an exudative pleural eIIusion, especially iI it is bloody, strongly suggest a malignant
etiology. An exudative pleural eIIusion in the patient with a current or past cancer is very likely
caused by the cancer.
In male patients about halI oI malignant eIIusions are caused by the lung cancer, 20 by
leukemia, 7 Irom gastrointestinal primaries,6 Irom genitourinary primaries and 11 Irom
tumors oI unknown primary site. In Iemale patients, about 40 oI malignant eIIusions are
caused by breast cancer, 20 Irom tumors arising in the Iemale genital tract, 15 Irom lung
primaries, 8 Irom leukemia, 4 Irom gastrointestinal tract primaries,3 Irom melanoma and
9 Irom tumors Irom unknown primary site.
The goal in treating a malignant pleural eIIusion is palliative, that is, to improve the quality oI
liIe and reduce symptoms but not to cure the cancer.
The diagnosis oI malignant pleural eIIusion is made by physical examination oI the chest, by
chest X-ray, by Cat Scan oI the chest, and by analyzing the Iluid that is drained Irom the chest.

The goal in treating a malignant pleural eIIusion is palliative, that is, to improve quality oI liIe
and reduce symptoms but not to cure the cancer.