What Causes Fluid Buildup in the Chest?

Fluid in the chest, a condition known as pleural effusion, is marked by a buildup of excess fluid around the lungs. It is also referred to as ‘water on the lungs’ or fluid buildup in the chest. There are several medical conditions that may cause fluid buildup in the chest. This fluid buildup may need to be drained, while your doctor also treats the underlying condition that caused this fluid accumulation. Here are the major causes of fluid buildup in the chest.

Fluid buildup in the chest, or pleural effusion, is a condition that causes an abnormal accumulation of fluid in the area between your chest cavity and the lungs.⁽¹⁾

While there is always a small quantity of fluid present within the lungs to help lubricate the lungs as they expand during breathing, but certain medical conditions can cause an abnormal amount of fluid to accumulate in this area.

Pleural effusions are more common than one would think, with nearly 100,000 cases being diagnosed in the US alone every year.⁽²⁾

Depending on the underlying cause, this excess fluid, which builds up, maybe either protein rich (known as exudative), or protein-deficient (known as transudative). These are the two categories that help doctors determine the exact cause of the fluid buildup in the chest.

The common causes of transudative (watery fluid) pleural effusions are:

• Pulmonary embolism: A blockage in any artery in one of the lungs that can cause fluid buildup
• Heart failure
• Cirrhosis
• As a complication of open-heart surgery

The most common causes of protein-rich (exudative) fluid buildup in the chest are:

• Pulmonary embolism
• Block blood vessels
• Lung injury
• Tumors
• Cancer
• Pneumonia
• Kidney disease
• Inflammatory disease

Some of the rare causes of pleural effusions are:

• Autoimmune disease: Rheumatoid arthritis or lupus are some autoimmune diseases that can cause pleural effusion
• Tuberculosis
• Bleeding due to chest trauma
• Chylothorax due to injury⁽³⁾
• Ovarian hyperstimulation syndrome
• Meig’s syndrome (caused by a benign ovarian tumor)
• Rare types of chest and abdominal infections
• Asbestos pleural effusion due to frequent exposure to asbestos

Leakage from other organs: This type of fluid buildup typically happens if you have congestive heart failure, a condition that occurs when the heart is unable to pump blood to the body properly. However, leakage from other organs can also happen due to kidney or liver disease. Such conditions cause fluid buildup in the body, and the fluid also leaks into the chest cavity or the pleural space.^{(4, 5)}

In some cases, people may not experience any symptoms of fluid buildup in chest or pleural effusion. These people only find out they have fluid buildup when they go for a physical examination, or they need to have a chest X-ray taken for some reason.

The common signs and symptoms of pleural effusion of fluid buildup in the chest include:

• Fever
• Dry cough
• Chest pain
• Shortness of breath
• Persistent hiccups
• Difficulty breathing deeply or taking deep breaths
• Having trouble doing usual physical activities
• Difficulty breathing even when lying down

If you experience any of the symptoms of pleural effusion, you should not delay in visiting a doctor as this is a serious medical condition.

If your doctor suspects fluid buildup in chest or pleural effusion, then your doctor will first perform a thorough physical examination and also listen to your lungs with a stethoscope. They are also likely to prescribe a chest X-ray to diagnose pleural effusion. Other tests that may also be ordered include:

• Chest ultrasound
• CT scan
• Pleural fluid analysis
• Bronchoscopy
• Pleural biopsy

In the case of pleural fluid analysis, your doctor will remove a tiny bit of fluid from the pleural membrane in the lungs by inserting a needle into the chest cavity. The fluid is then drawn out with a syringe. The procedure is known as a thoracentesis.⁽⁶⁾ The same process is also used to drain out the excess fluid from the chest. The fluid is then sent for testing to determine the underlying cause of the pleural effusion.

If needed, your doctor may also decide to perform a pleural biopsy.⁽⁷⁾ A pleural biopsy is performed by taking a tiny sample of tissue from the pleura, which are the membranes that line the outside of the lungs and also the interior of the chest cavity. The biopsy is performed by inserting a small needle from outside of the chest wall. It enters the chest cavity to take the sample.

If you are diagnosed with fluid buildup in chest or pleural effusion, but the doctors are unable to diagnose which type of pleural effusion you have, then a thoracoscopy might be scheduled.⁽⁸⁾ This is a surgical procedure that allows the doctor to check inside the chest cavity with the use of a fiber-optic camera.

For a thoracoscopy, a few small incisions are made in the chest area. The procedure is performed under general anesthesia. The doctors then insert the camera through one of the incisions, and the surgical tool is inserted through another incision. A small amount of tissue or fluid is then extracted for analysis.

Treatment for pleural effusion is typically determined by the underlying cause that has led to the fluid buildup. The severity of the effusion also plays a role in deciding what type of treatment will be chosen.

Here are some of the standard treatment options for fluid buildup in chest or pleural effusion:

The first stage of treatment usually involves draining the built-up fluid from the chest cavity. This is done either with a needle or by using a small tube that is inserted into the chest.

You will be given a local anesthetic before the drainage procedure behind, making the process more comfortable. You are likely to experience some discomfort or pain at the incision site once the anesthesia wears off. Most doctors prescribe some medication to help alleviate the pain.

If the fluid builds up again, you will need to undergo this procedure more than once.

If your pleural effusion is being caused by cancer, then other treatments would be required to manage the fluid buildup.

This is a type of treatment that causes mild inflammation between the chest cavity pleura and the lungs. After the excess fluid has been drawn out from the chest cavity, a doctor then injects a drug into the cavity. This drug is usually mixed with talc. The medication prevents the future buildup of fluid between the two layers of the pleura as it causes these two layers to stick together.⁽⁹⁾

In more severe cases of fluid buildup in the chest, surgical intervention may be required. In this, a doctor will surgically insert a small tube, or a shunt, into the chest cavity. This redirects the fluid from the chest cavity into the abdomen, where it is easily removed by the body. This is an option for people who do not respond to other forms of treatment.

Fluid buildup in the chest is a serious condition and can prove to be life-threatening. Most cases of pleural effusion require hospitalized treatment, and some severe cases may even require surgery. The size, severity, and cause of the effusion determines the time it takes a person to recover from this condition. Your overall health condition also has a role to play.

The recovery process begins in the hospital, but even after being discharged, most people report feeling fatigued in the first week. You will notice the incision sites from the treatment procedures beginning to heal within two to four weeks. Continued care, a healthy lifestyle, and proper follow-up with the doctor will be required even once you are home.

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