Grandma has atrial fib and unexplained left-sided pleural effusion

Hi Doctor, my Grandma was admitted to the hospital 6 months ago with shortness of breath.  They found left-sided pleural effusion and she was also in atrial fib (which was new.)  They did thoracentesis twice and found no evidence of malignancy, infection, etc.  Her chest x-ray also looked clear, except for the effusion.  Her cardiologist says the pleural effusion is not from her heart or kidneys.  The doctors aren't sure what is causing it.  She is diabetic and is on meds for it and she also watches her diet, just thought I'd add that in.  She was sent home with a PleurX catheter and she is now on Pradaxa for the atrial fib to prevent clots.  A nurse comes to the house every 2 days to drain her left lung. The fluid is clear and always has been from the start - transudative - sometimes it looks amber or burgandy now but they are saying that it most likely because of the blood-thinner she's on and from getting it drained so often (irritation.)  I'm just wondering what could be causing this left-sided pleural effusion that doesn't seem to go away.  She's had the catheter in for 2 months now, and the doctor is hoping the pleural space will close up on its own over time.  Hoping you can give me any advice on what else could be causing this effusion and also if it sometimes takes longer than 2 months for the effusion to resolve.  Thank you so much for any info!

[CCFCardio MD2]

I'm sorry to hear your grandmother is having some trouble.  Pleural effusions can be caused by a number of conditions.  I'm not sure what work your grandmother's physician has done to diagnose the etiology of the effusion.  If it is TRULY transudative, the most common causes are heart disease, liver disease, and kidney disease.  If it is exudative, the number of causes broadens.  If she is elderly and was a smoker, malignancy is at the top of the list.  If her initial thoracentesis was negative for malignancy, you may want to ask about repeating the cytology and getting a CT scan of the chest to rule out cancer.  Other causes include pulmonary embolism, rheumatoid arthritis, lupus.  It is true the blood thinner is likely contributing to the color change in the fluid, but again make sure your doctor isn't missing a malignancy.  Hope this helps.

[melmarie121]

Thank you so much for replying.  She's had cytology done twice (thoracentiesis was done twice) and they checked both times for cancer.  I think they were about 2 months apart.  But she has not had a CT, just chest X-rays, so we will look into it further.  Thanks again for your advice and Happy Holidays.

[mandi99]

A related discussion, left side pleural effusion was started.