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.