1. ETIOPATHOGENESIS OF PLEURAL
EFFUSION

2. Normal Physiology
• Normally pleural space contains a thin layer of
fluid.
• Fluid enters the pleural space from the capillaries
in the parietal pleural and is removed by the
lymphatics in the parietal pleura.
• Fluid can also enter the pleural space from the
interstitial spaces of the lung via the visceral
pleura or from the peritoneal cavity through the
diaphragm.

3. PATHOGENESIS
• Pleural fluid accumulates when
Formation increases
Absorption decreases
• Pleural effusion can be
Transudative
Exudative

4. • Transudative effusion occurs commonly due to
systemic factors which either increase the
hydrostatic pressure or decrease the plasma
oncotic pressure.
• Exudative effusion occurs due to local
pathology in the lung or the pleura.

5. AETIOLOGY
• Transudative pleural effusion
– Congestive cardiac failure
– Cirrhosis
– Pulmonary embolism
– Nephrotic syndrome
– Peritoneal dialysis
– Myxoedema

6. Exudative Pleural Effusion
• Neoplastic diseases
– Metastatic diseases
– Mesothelioma
• Infectious diseases
– Pneumonia
– Tuberculosis
• Gastrointestinal diseases
– Pancreatic disease
– Esophageal perforation
– Intraabdominal abscess
– Diaphragmatic hernia

7. Exudative Pleural Effusion
• Collagen vascular diseases
– Rheumatoid arthritis
– SLE
– Drug-induced lupus
– Immunoblastic lymphadenopathy
– Sjogrens syndrome
– Wegener’s Granulomatosis
– Churg-Strauss syndrome
• Asbestos exposure
• Sarcoidosis
• Uremia
• Meigs’ syndrome