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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