Pleural Effusion
- causes and risk factors
- signs, symptoms, and diagnosis
- pathophysiology
- treatments
- consequences and course
- the patient
- health care team
- community involvement
- resources and references
Usually there is no more than 15 ml of serous fluid in the pleural space.
Causes and Risk Factors
Increased pleural fluid accumulates over time in the following situations
Transudative (more often systemic disease)
- congestive heart failure, leading to fluid overload and increased hydrostatic pressure
- nephrotic syndrome
- liver disease, leading to decreased osmotic pressure
- other hypoalbuminemic states
- thyroid
Exudative (more likely local disease)
- pulmonary inflammation (pneumonia, turberculosis, abscess)
- cancer (lung, breast)
- pulmonary embolus and lung infarct
- pneumonia, leading to increased vascular permeability
- atelectasis, leading to increased intra-pleural negative pressure
- abdominal inflammation
- subphrenic abscess
- pancreatitis
- mediastinal involvement of cancer or other causes of decreased lymphatic drainage
- pulmonary embolism, though I am not sure how.
- autoimmune causes: SLE, RA
- asbestosis
- Dressler's syndrome - antimyocardial antibody syndrome
- Meig's
- sarcoidosis
- radiotherapy
Other fluids that can collect include pus (empyema - suppurative infection), blood (trauma, ruptured aneurysm) or lymph (tumour blockage of lymphatics).
Signs, Symptoms, and Diagnosis
- history
- physical exam
- lab investigations
- diagnostic imaging
History
shortness of breath
Physical Exam
Dull on percussion
Shift of trachea away from side of effusion
Decreased or absent breath sounds
decreased or ansent tactile fremitus and transmitted voice sounds, though may be accentuated at top of a large effusion
Lab Investigations
Fluid aspiration, followed by microscopic analysis of the fluid, is critical.
transudate vs exudate:
ratio of pleural fluid:serum - protein: 0.5, LDH: 0.6
Light's criteria for exudate
- fluid albumin: >0.5 serum albumin
- fluid LDH: >0.6 serum LDH
Diagnostic Imaging
Chest X rays show increased pleural space and rounding of the lung-diaphragm margin.
Pathophysiology
Treatments
For palliative measures, pleurodesis can be done by injecting inflammatory chemical to glue the pleural linings together. This prevents fluid accumulation in many cases.
Consequences and Course
The Patient
Health Care Team
Community Involvement
Resources and References
www.chestjournal.org/content/135/1/201.full