Pulmonary Edema vs Pleural Effusion: Key Differences | Credihealth

Fluid in the lungs can feel like drowning from the inside. But not all fluid-related lung problems are the same. Pulmonary edema and pleural effusion are the two common and most confused respiratory conditions that involve fluid buildup and shortness of breath. But they differ in where the fluid collects, why it happens, and how it’s treated. Understanding pulmonary edema vs pleural effusion is essential to recognizing the right symptoms and seeking the appropriate care.

In this article, we’ll break down the key differences, symptoms, causes, treatment options, and risks in simple terms that help you understand what’s happening and what to do.

Pulmonary Edema vs Pleural Effusion: Quick Comparison Table

Struggling to Breathe? It Could Be Pulmonary Edema or Pleural Effusion. Here’s How to Tell the Difference.

What Is Pulmonary Edema?

Pulmonary Edema is a respiratory condition marked by the buildup of fluid in the lung tissues & alveoli (small air sacs of the lungs), causing impaired gas exchange. When these sacs fill with fluid, breathing becomes harder because the lungs are unable to inhale enough oxygen. This condition can be life-threatening and needs emergency medical treatment. Over 1 million people are diagnosed with this disease each year in the USA.

What Is Pleural Effusion?

Pleural Effusion is a respiratory condition characterized by the buildup of excess fluid in the pleural space (a location between the chest wall and lungs). Normally, this area has a small amount of fluid that helps with the smooth movement of the lungs during breathing. However, excessive fluid leads to lung compression, making breathing challenging. Around 1.5 million people develop pleural effusion each year in the United States. 

Pulmonary Edema vs Pleural Effusion: Potential Causes

Understanding the cause is crucial for preventing the occurrence of diseases in the future and developing treatment.

Causes of Pulmonary Edema:

• Left-sided heart failure (most common)

• Kidney failure

• Lung damage due to infection, trauma, or smoke inhalation

• High altitude (High-altitude pulmonary edema – HAPE)

• Sepsis or acute respiratory distress syndrome (ARDS)

• Certain medications or overdoses

Causes of Pleural Effusion:

• Congestive heart failure (most common)

• Pneumonia (parapneumonic effusion)

• Tuberculosis

• Pulmonary embolism

• Cancer (especially lung, breast, ovarian)

• Liver cirrhosis

• Autoimmune diseases like lupus or rheumatoid arthritis

Symptoms: How to Tell Them Apart

Pulmonary edema can be acute (occur suddenly) or chronic (develop over time). Here are the symptoms of acute and chronic pulmonary edema:

Pulmonary Edema Symptoms:

Acute pulmonary edema symptoms:

• Shortness of breath (dyspnea), especially while lying down or moving

• Coughing up blood/frothy mucus

• Chest pain or tightness

• Wheezing (sharp, whistling sound during breathing)

• Gasping for air

• Feeling like suffocating

Chronic pulmonary edema symptoms:

This form develops symptoms similar to acute pulmonary edema, but, are milder. Other symptoms include:

Pleural Effusion Symptoms:

Some individuals develop no symptoms, while others experience the following signs of pleural effusion:

• Chest pain (sharp and worsens with deep breaths)

• Dry, non-productive cough

• Shortness of breath (gradual onset)

• Decreased breath sounds on the affected side

• Feeling of heaviness or pressure in the chest

Pro Tip: If the cough is wet with pink frothy mucus, it’s likely pulmonary edema. If it’s dry and you’re experiencing sharp chest pain, it may point to pleural effusion.

Risk Factors For Pulmonary Edema and Pleural Effusion

Risk Factors For Pulmonary Edema

In general, heart issues and heart failure are the main risk factors for developing pulmonary edema. Other factors that might put the people at risk are:

Risk Factors For Pleural Effusion

Risk factors may include:

• Medical issues that cause pleural effusion, including congestive heart failure, liver cirrhosis, and kidney disease

• Tobacco products

• Chest injury

• Asbestos exposure

Possible Complications Associated with Pulmonary Edema & Pleural Effusion

Pulmonary Edema Complications

If left untreated, pulmonary edema can lead to:

• Acute respiratory failure

• Hypoxemia (low oxygen blood levels)

• Respiratory distress syndrome (severe lung damage & interrupted gas exchange)

• Heart failure

• Cardiogenic shock

• Thromboembolism (blood clots in veins)

Pleural Effusion Complications

If untreated, pleural effusion can lead to:

• Lung damage

• Scarring around the lungs

• Pneumothorax (collapsed lungs)

• Infection, leading to sepsis (a life-threatening condition)

• Pleural Thickening (thickening of the lung’s lining)

• Treatment-related complications like pain, air leakage, and bleeding

Note: To prevent severe complications, it is important to report the symptoms immediately to the doctors and receive effective treatment. 

Diagnosis of Pulmonary Edema and Pleural Effusion

Pulmonary Edema Diagnosis

If the healthcare professionals suspect pulmonary edema, these tests are performed for proper diagnosis:

• Chest X-ray: Checks for fluid in the lungs.

• CT Scan: Identifies fluid buildup and examines the severity of the condition.

• Electrocardiogram (ECG): Detects heart problems.

• Echocardiogram: Assess heart function and identify any abnormalities that cause fluid accumulation.

• Blood Tests: Detects kidney failure or infections and measures electrolyte and oxygen levels.

• Pulmonary Function Tests: Evaluate lung capacity and function. 

Pleural Effusion Diagnosis

For pleural effusion diagnosis, the healthcare professionals use:

• Chest X-ray: Check for fluid in the pleural space.

• Ultrasound: Helps with fluid removal.

• CT Scan: Helps with detailed pictures of the chest that clearly help detect fluid accumulation.

• Thoracentesis: Identifies the cause and analyzes the accumulated fluid.

• Blood tests: Detect the presence of infection, contributing to the condition.
  

Treatment of Pulmonary Edema and Pleural Effusion

Pulmonary Edema Treatment

Pulmonary edema treatment depends on the potential causes, but may include:

• Oxygen Therapy: Helps with easier breathing by delivering 100% oxygen through oxygen masks, positive pressure masks, or nasal cannulas.

• Diuretics: Examples include furosemide to get rid of excessive accumulated fluid from the body.

• Mechanical ventilation (in severe cases): Enhances gas exchange, lowers breathing work, and improves cardiac function.

• Treatment of the underlying causes:

1. Antibiotics for infections,

2. Calcium channel blockers for high blood pressure

3. Inotropes for heart failure

4. Morphine for shortness of breath and anxiety

5. Preload reducers to reduce fluid pressure on the lungs and heart.

6. Afterload reducers to dilate the blood vessels and take off the load from the heart.

Emergency alert: Acute pulmonary edema requires immediate hospitalization, especially if caused by heart failure or ARDS.

Pleural Effusion Treatment

Treatment is based on the underlying causes and might include:

Medicines:

• Diuretics for congestive heart failure

• Antibiotics for infections

• Chemotherapy, a drug treatment for malignant (cancerous) pleural effusion.

Therapeutic Thoracentesis

Surgery

In severe cases, the following surgeries are recommended to remove some part of the pleura or insert a shunt to drain fluid.

• Video-assisted thoracoscopic surgery: Involves making 1-3 small incisions (cuts) on the chest to drain the fluid that is difficult to remove or recur because of the tumor.

• Thoracotomy (“open” thoracic surgery): Involves making a 6-8 inch cut on the chest to remove the fibrous tissues, which help treat infection from the pleural space. 

How To Prevent Both Respiratory Conditions?

To prevent pulmonary edema, follow these tips:

• Take medications as prescribed to manage heart conditions and other medical issues.

• Consume a balanced diet rich in healthy fats, whole grains, fruits, and vegetables. Limit salt, added sugar, and trans and saturated fats.

• Do not smoke as it damages the lungs and heart.

• Limit alcohol use, as it leads to weak lung muscles and increased heart failure risk.

• Maintain a healthy body weight, as being overweight increases the risk of heart disorders.

• Avoid high altitudes, as they can lead to breathing issues.

• Go for a regular health checkup, especially if you face difficulty in breathing. This helps with proper monitoring & preventive care.

To prevent pleural effusion, follow these tips

• Take medications as prescribed to treat heart failure and other health problems.

• Get vaccinations against influenza and pneumonia to protect against respiratory infections.

• Quit smoking, as it increases the risk of heart and lung diseases.

• Follow a healthy diet, especially low in salt, as it reduces fluid buildup. Limit sugar, trans & saturated fats, and alcohol because they trigger inflammation in the heart.

• Maintain hand hygiene by washing hands frequently to alleviate the risk of spreading infections. 

• Limit fluid intake if the healthcare professional advises to prevent fluid accumulation. 

• Avoid asbestos, as it causes inflammation and fluid accumulation. If your work demands asbestos exposure, follow safety precautions. 

Prognosis: What’s the Outlook?

The outcome depends on the underlying cause, the speed of diagnosis, and how early treatment begins.

Pulmonary Edema

• Pulmonary edema, particularly when caused by medical conditions like acute respiratory distress syndrome or congestive heart failure, can be fatal and leads to an increased risk of mortality (death).

• The quick buildup of fluid within the lung tissues can cause severe respiratory failure and hypoxia (insufficient oxygen levels in the blood) if not immediately treated.

Pleural Effusion:

• Pleural effusion, especially if caused by pulmonary embolism, can significantly raise the risk of death.

• Research has reported that pleural effusion increases 30 days and in-hospital death rates in people with pulmonary embolism. 

Final Thoughts

If you’re experiencing unexplained shortness of breath, coughing, or chest discomfort, don’t ignore the symptoms. Understanding the difference between pulmonary edema vs pleural effusion is crucial, as timely diagnosis and the right treatment can be life-saving. While both conditions involve fluid accumulation and affect the lungs, their causes, locations, symptoms, and treatments differ significantly. Appropriate diagnosis and a customized treatment plan are crucial for effective treatment and preventive care. Comparatively, pleural effusion is life-threatening and requires immediate medical attention.

Talk to a healthcare professional and get the right tests done — your lungs will thank you.

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