PLEURAL EFFUSION

Fluid accumulation in pleural space.
Clinical Picture
  • Patients present with shortness of breath and cough.
  • Can be asymptomatic and recognized on routine CXR.
  • Dullness with decreased breath sounds and mediastinal shift can be seen.
  • Chest x-ray shows fluid in pleural space with classical meniscus. Additional findings will depend on the etiology.
Etiology
Multiple etiologies can give rise to pleural effusion. Following are the common.
  • Congestive heart failure
  • Malignancy
  • Parapneumonic
  • Tuberculosis
  • Rheumatoid arthritis
Pathophysiology
Mechanisms leading to accumulation of fluid in pleural spaces vary. Following are some.
  • Increased hydrostatic pressure eg CHF.
  • Increased capillary permeability eg malignancy
  • Direct extravasation eg Chylothorax
  • Negative pressure induced eg trapped lung
Diagnosis
  • Pleural effusions are categorized as exudates and transudates.
  • Thoracentesis is essential to obtain fluid for appropriate studies based on the clinical setting.
  • Malignancy is the most common cause of exudative effusions and should be ruled out with cytological exam.
  • In undiagnosed effusions one have to consider pleural biopsy either by blind method or by thoracoscopy.
Treatment

  • Appropriate specific therapy based on the etiology.
  • Therapeutic thoracentesis may be required to relieve shortness of breath.
  • Pleural sclerosis will be a consideration in malignant effusions to prevent recurrence.

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