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Pleural Effusion
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Pleural Effusion
Anatomy of lung
โ€ข The lung
is a vital organ
responsible for gas
exchange.
โ€ข It is
surrounded by two thin
membranes called the
pleurae.
โ€ข The
visceral pleura covers
the lung surface.
โ€ข The
parietal pleura lines
the inner chest wall.
Visceral pleura
โ€ข Thin, transparent
membrane
covering the lung
surface.
โ€ข Composed of
mesothelial cells
and a thin layer of
connective tissue.
โ€ข Secretes pleural
fluid for lubrication
and protection.
Pleural cavity
โ€ข The potential space
between the
visceral and parietal
pleurae.
โ€ข Contains a small
amount of pleural
fluid for lubrication.
โ€ข Allows the lungs to
expand and
contract smoothly
during breathing.
Parietal pleural
โ€ข Thin,
transparent
membrane
lining the inner
chest wall.
โ€ข Composed of
mesothelial
cells and a
thicker layer of
connective
tissue.
โ€ข Anchors the
lung to the
chest wall.
Anatomy
Pleural Effusion Physiology
Pleural fluid formation , maintenance
โ€ข Pleural fluid is
produced by the
visceral pleura and
absorbed by the
parietal pleura and
lymphatics.
โ€ข This process
maintains a delicate
balance, ensuring
minimal fluid
accumulation in the
pleural cavity.
โ€ข Disruptions in this
balance can lead to
pleural effusion.
Pleural Effusion Definition
โ€ข Abnormal
accumulation of
fluid in the pleural
cavity.
โ€ข Can be caused by
various underlying
conditions.
โ€ข Can be classified
as transudative or
exudative based
on the protein
content of the
fluid.
Pleural Effusion
โ€ข Normal pleural
space: minimal fluid
visible.
โ€ข Small pleural
effusion: less than
10mm thickness on
chest X-ray.
โ€ข Large pleural
effusion: more than
10mm thickness on
chest X-ray.
Pleural Effusion
Prevalence
โ€ข Pleural effusion is
a common
condition,
affecting millions
of people
worldwide.
โ€ข The prevalence
varies by region,
with higher rates
in developing
countries.
Prevalence
โ€ข The
prevalence
of pleural
effusion
increases
with age.
โ€ข The
condition is
more
common in
men than
women.
Prevalence
โ€ข The
prevalence of
pleural
effusion also
varies by
underlying
condition.
โ€ข Heart failure is
the most
common
cause,
followed by
pneumonia
and cancer.
Prevalence
Risk Factors
โ€ข Heart failure: the
leading cause of
transudative pleural
effusions.
โ€ข Cirrhosis: due to
increased portal
vein pressure.
Risk Factors
โ€ข Pneumonia:
infection leading to
exudative pleural
effusions
Pulmonary embolism:
blockage of a main
pulmonary artery
leading to transudative
pleural effusions
Risk Factors
o Asbestos
exposure
o Pancreatitis
o Post-surgical
complications
o Liver failure
o Kidney failure
o Smoking
o Alchol
Types
Little drainage
Excess production
Types
Light criteria Aspects
Transudative Vs Exudative Infographics
Exudative:
โ€ข Fluid with high protein
content
โ€ข Caused by
inflammation or other
pathological
processes
โ€ข Common causes:
pneumonia,
malignancy,
pancreatitis
โ€ข Treatment:
addresses underlying
cause, may require
thoracentesis or
chest tube drainage
Transudative pleural effusion causes
o
Increa
sed
systemic/pulmonar
y capillary pressure
and decreased
osmotic pressure.
o Major
causes: cirrhosis,
heart failure,
nephrotic
syndrome, protein-
losing enteropathy
Causes
Congestive heart
failure: The leading
cause of transudative
pleural effusions.
Increased
hydrostatic pressure
in the pulmonary
capillaries leads to
fluid leakage into the
pleural space.
Transudate pleural effusion causes
Cirrhosis: Increased
portal vein pressure
due to cirrhosis
leads to transudative
pleural effusions
through a complex
mechanism involving
fluid retention and
lymphatic
dysfunction.
Causes
Exudative pleural effusion causes
o Local
processes leading to
increased capillary
permeability.
o Fluid,
protein, cells, and serum
constituents exude.
o Major
causes: inflammation,
infection, lung injury,
tumors, lung cancer,
rheumatoid arthritis,
pneumonia,
tuberculosis, surgical
damage, lymphatic fluid
accumulation
Exudative pleural effusion causes
โ€ข Pneumonia: A
common cause of
exudative pleural
effusions, leading
to inflammatory
changes in the
pleura and
increased protein
content in the
pleural fluid.
Exudative pleural effusion causes
โ€ข
Mal
ignancy: Cancer
cells can directly
invade the pleura
or indirectly
cause pleural
effusions through
various
mechanisms.
โ€ข
Lun
g cancer, breast
cancer, and
lymphoma are
some examples
of malignancies
associated with
exudative pleural
effusions
Exudative pleural effusion causes
โ€ข Pancreatitis:
Inflammation of the
pancreas can cause
exudative pleural
effusions through
mechanisms
involving increased
capillary permeability
and lymphatic
dysfunction.
Pulmonary embolism:
Blockage of a main
pulmonary artery can
lead to exudative pleural
effusions due to
increased pulmonary
vascular pressure and
fluid leakage.
Lymphatic Pleural Effusion chylothorax
โ€ข Accumulation of
chyle (lymphatic
fluid rich in fats)
in the pleural
space.
โ€ข Caused by
obstruction or
disruption of the
Lymphatic Pleural Effusion Causes
โ€ข Causes:
Trauma to the thoracic
duct, surgery,
malignancy,
lymphedema.
โ€ข Symptoms:
Dyspnea, cough, chest
pain, weight loss, fatigue.
โ€ข Diagnosis:
Chest X-ray, CT scan,
thoracentesis (fluid
analysis).
โ€ข Treatment:
Drainage (thoracentesis,
chest tube), dietary fat
restriction, octreotide
(medication to decrease
chyle production),
surgery (in severe cases).
Symptoms
โ€ข Dyspnea
(shortness of
breath)
โ€ข Labored
breathing
โ€ข Non-productive
cough
โ€ข Chest tightness
โ€ข Orthopnea
(difficulty
breathing lying
down)
Dyspnea
The most common
symptom, occurring
from mild to severe
depending on the
amount of fluid and its
impact on lung
function
Symptoms
โ€ข Cough:
Dry, non-productive
cough can occur due
to irritation of the
pleura or underlying
respiratory
conditions.
โ€ข Chest
pain: Pleuritic pain is
sharp, worsens with
deep breaths, and
results from
inflammation of the
pleural surfaces.
Symptoms
โ€ข Other
symptoms: Fatigue,
weight loss, lethargy,
and fever can occur
depending on the
cause of the pleural
effusion and its
impact on the body's
overall function.
Diagnosis
โ€ข Physical
examination
โ€ข Chest
radiographs
โ€ข Imaging
Diagnosis
Physical Examination
โ€ข Physical
examination:
Inspection,
palpation,
percussion, and
auscultation can
reveal signs like
decreased breath
sounds, dullness
to percussion,
and tactile
fremitus.
Imaging
โ€ข Chest radiographs:
X-rays are the initial
imaging test,
showing the
presence and size
of the pleural
effusion.
โ€ข Imaging: CT scans,
ultrasound, and MRI
can provide more
detailed information
about the effusion,
underlying lung
abnormalities, and
potential causes.
Imaging
Drainage
Used for larger
effusions or
persistent fluid
accumulation
Drainage
Pleurodesis
โ€ข (scarring of
pleural space):
Used to prevent
recurrent
effusions by
chemically or
mechanically
irritating the
pleura.
Surgical procedure
Thoracentesis (fluid
removal)
Catheter drainage
Pleurodesis (scarring
of pleural space)
Pleuroperitoneal
shunt (fluid drainage
to abdomen)
Pleurectomy (surgical
removal of pleura)
Thoracoscopy (visual
examination of
pleural space)
Thoracostomy
(surgical opening of
chest cavity)

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