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Can pleural effusion be malignant ?

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General & Family Physician
Practicing since : 2011
Answered : 243 Questions
Hi Doctor,
I would like to get an idea of the likelihood of my pleural effusion being malignant. They have withdrawn fluid and sent it for analysis, but I am having a hard time waiting for the result.
I have had pnemonia first in left lung then in right lung. The pleural effusion was identified with left lung pneumonia. It has not grown in size over a period of 4-6 weeks. When they took fluid out, it was bloody, but I have been on warfarin for years, and it could have been due to that, or even during the insertion of the needle.

I have been on antibiotics (again) for 10 days and today is my last day. I was in the hospital for about a week, but discharged 2 days ago. Even though I am on the antibiotic, I am running a slight fever (99.6) This is worrisome to me.
Thank you, XXXXXXX
When I read my history it is a little startling, however up until recently I have been functioning as though I had no problems.
Wed, 11 Apr 2012 in Cancer
Answered by Dr. Sapan J. Pandya 27 minutes later
Dear Nan Taichi,

Thanks for your query,

By the end of this session, I hope that I would have solved your queries.

No, according to my clinical acumen, it does not seem that the pleural effusion contains malignant liquid. It seems more likely that the effusion is infective in nature.

The reasons why I believe so are: You have a recent history of lung infection. In fact, you have still not recovered from pneumonia. The infected lungs tend to spread the infection to the pleura which cover the lungs and is reflected as Pleural Effusion.

The blood in the collection seems to because of the puncture while collecting the effusion.

Waiting for your follow-up
Above answer was peer-reviewed by
Follow-up: Can pleural effusion be malignant ? 1 hour later
Thank you Dr. Pandya,

I greatly appreciate your response. It is so helpful that you not only give your opinion, but also the reasons for your opinion.
My anxiety level is very high, therefore I am having difficulty even phrasing questions, much less giving you appropriate information.

I neglected to mention is that the doctors here seem to feel I also have a trapped lung (partially). Is this a consequence of pneumonia? or the pleural effusion? Or possibly from another cause altogether?

And is the fact that I currently have a low grade temperature even though I am on an antibiotic of any concern?

Thank you so much.
Answered by Dr. Sapan J. Pandya 6 hours later
Hello again! Nan Taichi,
Thanks for writing back.

It is natural to feel anxious when you are waiting for the report of biopsy. It can be mind-wrecking. With 16 years of dealing with human life has given me some level of sensitivity to understand the amount of stress you are undergoing at the moment. I hope that the reports are normal.

Unexpandable / trapped lung may occur due to pleural restriction. In your case pleural effusion will not allow the lungs to expand properly. Trapped lung may also be a sequel of an inflammatory condition (pneumonia in your case) which has resolved, but left behind a fibrous layer.

You may have to undergo a blood culture & sensitivity test (antibiogram) to know what antibiotics you are sensitive to. Your pleural fluid can also indicate which antibiotics may be given to you.

Wish you good health
Above answer was peer-reviewed by
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