Ever notice how some things seem to come in bunches? In summer gardening it’s the zucchini, tomatoes or green beans that seem to all ripen at the same time. This analogy holds true for our practice as well. Recently, we have seen a significant number of patients with fluid accumulations in the chest. This fluid accumulation is called a pleural effusion or “effusion” for short. The accumulations of fluid in the chest is never normal and is always secondary to some other disease process. Identifying the disease process causing an effusion is very important because it points the way to the appropriate therapy.

Effusions come in two general categories: those that are associated with inflammation and those that are not. Knowing what variety of effusion is present can sometimes be determined by the history but in most cases we need a sample of the fluid to send to the lab for analysis. Fluid that is not associated with inflammation such as fluid associated with heart failure or fluid overload can often be treated with medication and, hopefully, will absorb. Effusions that are associated with inflammation will usually not absorb and will most likely need some type of procedure to resolve them.

Thoracentesis is the name of the procedure where we place a small tube in the chest and remove small or large amounts of the chest fluid for analysis. This procedure can often be done in the office as an outpatient. Next week: Treatment strategies.