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Dr. Andrew Rynne

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Can pulmonary hypertension cause pleural effusion?

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Dr. Ilir Sharka

Cardiologist

Practicing since :2001

Answered : 5020 Questions

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Posted on Wed, 16 May 2018 in Hypertension and Heart Disease
Question: Hello,
I have a question about pleural effusion. I understand that there are many causes of this. I recently had a thoracic spine MRI for back pain that was normal; however, they noted a "tiny right-sided pleural effusion." Several years ago, around three, I had another thoracic MRI that was normal and again noted a "small right-sided pleural effusion." It seems odd that this would be noted twice and I'm curious what could cause a pleural effusion that doesn't leave. I have congenital heart disease (coarctation repaired twice in childhood, an unrepaired BAV, an unrepaired ASD, a subaortic membrane, and a sub-aortic membrane). At my last heart XXXXXXX (seven years ago), I had the very beginning stages of pulmonary hypertension (but I have no cardiac symptoms unless I'm at altitude). So, I'm guessing that probably plays a role in the pleural effusion. Otherwise, I am healthy, a non-smoker, and I feel perfectly fine (except for back pain that surrounds my co-arc scar which is why I had the MRI).
doctor
Answered by Dr. Ilir Sharka 1 hour later
Brief Answer:
I would explain as follows:

Detailed Answer:
Hello!

Welcome back on HCM!

I passed carefully through your concern and would like to explain that you are right about etiology of pleural effusion: in fact there are several causes.

But considering your medical history, the most probable causes of your pleural effusion could be any of the following too:

- post-pericardiotomy syndrome, which is an inflammatory reaction following pericardiotomy during cardiac surgery (especially correction of congenital cardiac defects). It may be associated with pericardial fluid and not rarely with pleural effusion. It usually appears several weeks to months after cardiac surgery, but sometimes it may appear, relapse or persist many years after a surgical intervention.

- right heart failure may be associated with systemic venous congestion and frequently fluid accumulation within the serosa. Pleural effusion is a common finding in this clinical scenario. So, it is frequent that after persistent pulmonary hypertension, a subsequent right heart dysfunction may appear and pleural effusion occurs.

It is necessary to perform a careful differential diagnosis workup in order to specify any of the above mentioned alternatives.

A new cardiac ultrasound and additional blood lab tests (liver and renal function tests, NT-pro BNP), a chest X ray or a lung ultrasound etc., should be performed in order to arrive to the right and exact conclusion.

This is my opinion and I hope to have been helpful to you!

If you could provide me with more additional available medical tests (cardiac ultrasound, etc.), I would be glad to give a more detailed professional opinion.

I remain at your disposal for any further questions, whenever you need!

Kind regards,

Dr. Iliri
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Ilir Sharka 24 minutes later
What's interesting is that my cardiac stuff does not pick up the effusion.

So, in 2015 I had an MRI that said there was a small pleural effusion in my right lung. I discussed this with my heart doctor who ordered an echo. She didn't see any effusion. Since then, I have had two other echos (I have them at least once a year), and 2 cardiac MRIs that have all been normal (at least normal for me - they didn't mention any effusion). I've also had several chest xrays, including one a few weeks back that was normal.

However, I asked someone on this site about it and he did mention that one of the veins (or arteries, I can't remember) was more prominent than it was supposed to be which was indicative of pulmonary hypertension. So maybe that's a factor. It's just odd to me that none of my other tests ever see the pleural effusion except for a thoracic MRI. The first MRI mentioned that it was "small" and the second said "tiny" so I'm assuming it hasn't worsened at all in the past three years.

I have been told that I have a great deal of venous congestion in my heart that always shows up on echo. I have also been told that my heart works much better than it should. They don't know why it works so well but it does despite all the issues and all the turbulence that appears. I am very strict about my lifestyle, which might play a role. I exercise all the time and I'm thin. I also live in XXXXXXX which they think might help because we're better conditioned from living at altitude.

I recently had blood tests performed for a routine physical and the only thing abnormal was my ferritin level (I don't eat meat).

I also have asthma (not sure if that matters) as well as a fully occluded IVC. And though I don't have kidney disease, I have had issues with my kidneys when taking certain medications.

The surgeries I had were years ago (39 and 34 years). However, I have had several heart catherizations since then. I'm not sure if that's enough to inflame the pericardiotomy.

I know that my aortic valve is leaky, though not enough to require surgery yet. So, in regards to the right-sided heart failure, is it possible to have pleural effusion not because of complete heart failure but just because your heart is compromised?

Oh, I also have a paralyzed diaphragm on the right side. Not sure if that matters.
doctor
Answered by Dr. Ilir Sharka 1 hour later
Brief Answer:
I would explain as follows:

Detailed Answer:
Hello again XXXX,

First, I would like to explain that there is no need to worry about such small amount of pleural effusion, as there are several reasons why this effusion may exist. A tiny effusion is clinically quite trivial. It is not life-threatening at all and does not interfere at all with your physical performance and everyday activity.

It is not rarely that an unrepaired ASD to be associated with pleural effusion.

It remains to be carefully reviewed the potential implication of pulmonary hypertension to your breathing problems. Not rarely a cardiac asthma is misdiagnosed as bronchial asthma.

From the other side, a chronic tiny pleural effusion may be a sign of chronic and well compensated heart failure.

You should know that heart failure is a clinical syndrome and not just an isolated heart dysfunction.

Systemic inflammation, frequently plays a role in body fluid redistribution.

That's why it is necessary to perform a differential diagnosis of the pleural effusion, where heart failure seems to be a crucial issue of discussion.

Finally, I would encourage you to closely monitor your pulmonary hypertension as its progression has important clinical implications in your clinical condition and prognosis.

Hope to have clarified some of your uncertainties!

Wishing good health,

Dr. Iliri

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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