Pleural effusion or Fluid inside the chest in children: causes, diagnosis & treatment!!

Pleura is a thin layer of tissue which covers the lungs and lines our chest cavity. Pleura normally secrete a small amount of fluid called pleural fluid, which functions as a lubricant. The pleural fluid helps the lungs to move smoothly while breathing. Pleural effusion is a condition where fluid builds inside the pleural space.

What causes pleural effusion in children?
The most common cause of pleural effusion in children is infections of which commonest is a bacteriaL pneumonia. Tuberculosis is another common cause of pleural effusion in children. Other infections that can cause pleural effusion in children are viral pneumonias and mycoplasma.

Congestive heart failure and nephrotic syndrome can also cause pleural effusion. Rheumatic conditions such as systemic lupus erythromatosus, juvenile idiopathic arthritis and Kawasaki disease are uncommon causes of pleural effusion. Rare causes of pleural effusion are malignant illnesses like lymphomas, leukaemia, Ewing’s sarcoma and PNET.

What are the symptoms of pleural effusion in children?
The fluid inside the chest cavity causes pressure effects on the lungs. This leads to difficulty breathing, fast breathing, chest pain and a low oxygen level. Pleural effusion if large the extra fluid pushes on a lung causing it to collapse. The disease causing the pleural effusion can also lead to symptoms such as fever, cough, weight loss and poor appetite.

How do we diagnose the cause of pleural effusion in children?
If the child’s case history and examination of the chest is suggestive of pleural effusion a Chest X-ray and ultrasound of the chest is done. In most situations removal of a small amount of fluid is required for investigation. This can easily be done using a small needle under local Anesthesia. This procedure is called thoracocentesis. The pleural fluid is then sent to the laboratory for analysis like presence of types of cells, sugar & proteins, cultures for bacteria and tuberculosis. Recently advanced molecular investigations are also available like GENEXPERT for diagnosis of tuberculosis.

How do we treat pleural effusion in children?
Treatment of pleural effusion involves removing the fluid and treating the underlying cause. In some cases if the fluid is causing significant compression on the lung leading to problems in breathing, a tube is put in to drain the fluid. Antibiotics are given for bacterial infections and Anti tubercular medicines for tuberculosis.

If your child is having pleural effusion you need to consult a pediatric Pulmonologist for proper diagnosis and treatment.

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