Pleural effusion following pneumonia

[Shaz90]

Hi, just after advice really, my husband went to a&e with chest pains last month. And was diagnosed with left basal pneumonia. And was sent away with antibiotics. He did not improve at all and actually developed a cough and shortness of breath ( previously the only symptom he had was severe pleuritic chest pain he also had high WBC and CRP and only a low grade fever)

We went back to the doctor who prescribed stronger antibiotics and gave another chest XRay, this showed a pleural effusion. Which is now two thirds of his lung.

After these antibiotics he felt ten times better but still had the shortness of breath and cough, but we had our follow up appointment for the day after antibiotics and was sent to hospital for further tests.

The xray shows no movement on the pleural effusion, they also did a CT scan. But this time his bloods were normal.

We have to go back in Monday for a drain but I suppose my question is, why is the effusion still there, he has no symptoms other than the cough and shortness of breath, his body is no longer showing infection signs. The cough is dry and he has no fever.

I should also mention he’s 28.

Basically I just was hoping someone had been through something similar and can help because my mind is now wandering to all sorts of horrible scenarios of dare I say it... cancer or something)

[Hidden]

This is common with pneumonia and is often called an empyema. I had one in 2015 when my GP let me walk around for 6 weeks with untreated pneumonia. I have non cf bronchiectasis and she mistook it for a problem with that. As there is so much fluid trapped in there your husband will need it taken away. Do ask if this can be done by needle aspiration and scanner rather than a drain as this is far kinder. A course of IV antiobiotics to clear up any lurking infection wouldn’t be a bad idea either. He will need patience because pneumonia takes a long time ( months) to feel better, especially with this complication. Good luck. I hope that things start to look up for him.He must keep an eye on himself and go straight back to the GP if he starts to feel that another infection is starting up. If he smokes he needs to just stop.

[Shaz90 in reply to Hidden]

Thankyou so much for responding! They did say it hasn’t become a full empyema yet as he looks and feels fit as a fiddle. They said it’s liquid not pus. But I know what you mean about the untreated part. He started getting back pain 3 weeks before the chest pain started.

I just find it baffling that someone who had, no fever, no sputum production, and feels extremely well, has so much fluid on his lung.

I think the antibiotics have killed most of the nasties now as all of his bloods have returned to normal.

We are going for the drain Monday and I think they are using needle. They tried last night but I don’t think this doctor had a clue what he was doing and he didn’t manage to draw off any fluid. So need to see a chest person Monday.

It’s so scary!

I hope you recovered well though! Xx

[Hidden in reply to Shaz90]

The funny thing with pneumonia and effusion is that there can be nothing to cough up because it is the cavity. With bronch I have a lor of mucus to clear every day. When I had the pneumonia the doc couldn't hear anything in my lungs and I couldn' cough anything up. In fact, the pressure of the fluid in the cavity was squashing the mucus in my lungs so that it couldn't be heard. I am sure that once it is dealt with he will recover fine.

[Hidden in reply to Shaz90]

Yes he definitely needs a physiologist with expertise in these procedures. There was no pain at all when they did mine.

[Shaz90 in reply to Hidden]

So people actually can have pneumonia and pleural effusion with no prior illness and main symptom was chest pain ( until the effusion developed then he got breathless and cough

[Hidden in reply to Shaz90]

Yes, there are a lot of diff pneumonias. Many are community aquired and being young, I doubt if your friend had been vaccinated. That is exactly how they start with no apparant warning and many docs find it difficult to recognisw because it doesn't present as a chest infection. It lurks deep down whilst it is doing its damage.

[Shaz90]

As an update, my husband went in for a pleural aspiration yesterday, the doctor stopped after a small amount and insisted a drain needed to go in because the colour of the fluid was “not good” it was like a red colour, clear, kind of like cranberry juice if I had to describe it.

He had over a litre drained overnight and had been sent home with 4 weeks of coamoxiclav with a follow up appointment at the pleural clinic in 4 weeks. I can’t stop thinking worst case with what’s causing it. The doctors have described it as a parapneumonic effusion, a complicated one but not an empyema as there was no pus but there was different pockets of fluid and it was very fibronous. He’s currently in a bit of pain and very tired.

He’s only 28, always been in good health so this has really baffled us. But I’m hoping after the drain and with these antibiotics he will continue to improve.

I guess writing this gives me a sense of outlet because I need to be strong for him.