Pleural effusion, its types & causes. how to make a clinical approach.

1. By Dr Asad

3. Abnormal collection of fluid in the pleural
cavity is called pleural effusion.

4. Transudative
Exudative

6. Commonly associated with cardiac , renal
and hepatic diseases.
Rarely associated with superior vena cava
obstruction.

7. Exudative pleural effusion most commonly
in children occurs due to infection of lungs
(BACTERIAL PNEUMONIA) or with
inflammatory conditions of mediastinum or
abdomen.
Occasionally found in connective tissues
disorders.
It may occur primarily in neoplasm of
lungs, pleura and mediastinum.

8.  Clinical features depend upon the amount of
fluid, usually small amount remain
asymptomatic
 Early signs pleural pain which aggravates
with deep breathing, and with increase in
amount of fluid pain subsides.
 Large fluid collection can produce cough,
dyspnea, tachypnea, orthopnea or cynosis.
 Percussion note is dull.
 O/A depend upon amount of effusion like in
extensive pneumonia there will be crackles
and ronchi to complete absent of air entry.

9. Radiographic examination shows
homogeneous density oblitrating the
normal markings of the underlying lung,
may vary from obliteration of costophrenic
angle or cardiophrenic angles.
Films should be done both supine and
upright, to demonstrate a shift of effsion.

13. CBC , U/C/E
Ultrasound guided thoracocentesis if
effusion is loculated
Fluid DR + CS + gram staining + cytology+
glucose level+ LDH level.

14.  The treatment of pleural effusion is treating
the underline cause.
 If the effusion is less than 10mm size on X-
ray chest then there is no need for drainage.
 When Diagnostic thoracentesis is performed
then try to drain as much as possible fluid but
drain slowly if you are planning to drain large
amount of effusion.
 Suspected parapneumonic effusion tube
thoracostomy is considered.
 Those with acute pneumonia may need
oxygen support with specific antibiotics.

15. 
 Thank
you