3. Definition and Introduction
๏ต The accumulation of fluid within the pleural space is termed pleural effusion
๏ต The pleural space normally contains only about 10-20ml fluid
๏ต Pleural effusion is a collection of abnormal amount of fluid in the pleural space
๏ต It can occur by itself or can be the result of surrounding parenchymal disease like
infection, malignancy, or inflammatory conditions
๏ต The accumulation of pus is termed empyema , that of blood is haemothorax, and
that of chyle(made of lymph and tiny fat droplets) is a chylothorax
๏ต Pleural fluid accumulates as a result of either increased hydrostatic pressure or
decreased osmotic pressure(transudative effusion, as seen in cardiac, liver or renal
failure), or from increased microvascular pressure due to disease of the pleura or
injury in the adjacent lung (exudative effusion)
5. Transudative effusions
๏ต Also known as hydrothoraces, occurs primarily in non-
inflammatory condtions:
๏ต Is an accumulation of low-protein, low cell count fluid
Cause of transudative effusion
โข Increase hydrostatic pressure found in heart failure ( most
common cause of pleural effusion)
โข Decrease oncotic pressure (From hypoalbuminemia) found in
cirrhosis of liver or renal disease.
โข In this condition, fluid movement is faciliated out of the
capillaries and into the pleural space
6. Exudative effusions:
๏ต Exudative effusions occur in an area of inflammation; is an
accumulation of high-protein fluid.
๏ต An exudative effusion results from increased capillary
permeability characteristic of inflammatory reaction.
๏ต This types of effusion occurs secondary to conditions such as
pulmonary malignancies, pulmonary infections(TB,
SUBPHRENIC ABSCESS, bacterial or fungal infection) and
pulmonary embolization.
7. Causes and Etiology
Common causes
โข Pneumonia (parapneumonic effusion)
โข Tuberculosis
โข Pulmonary infarction
โข Malignant disease
โข Cardiac failure: may cause bilateral effusion
โข Subdiaphragmatic disorders (subphrenic abscess,
pancreatitis etc.)
11. Clinical Features
Clinical features are those caused by the underlying disease and severity of
effusions
Symptoms
โข Fever : chills and rigor
โข Chest pain:
โข Shortness of breathe
โข Cough
Signs
โข Decreased breathe Sound
โข Dullness on Percussion
12. Diagnosis and Investigation
โข Chest x-ray (around 200ml fluid required to detect in xray)or USG scan to
detect fluid
โข Diagnostic Thoracentesis: for Biochemical, bacteriological and cytological
studies
Others : to determine causes and etiology
๏ต CBC: leukocytosis or leukopenia, and others evaluative tests: RFT,LFT, s.LDH
๏ต Pleural aspiration and biopsy
๏ต CT-scan of chest
๏ต Echocardiography: to rule out cardiac disease
๏ต USG A/P: to rule out liver disease
18. Management / Treatment
Objectives of treatment are
๏ต to discover the underlying cause,
๏ต to prevent reaccumulation of fluid, and
๏ต to relieve discomfort, dyspnea, and respiratory compromise
General treatment
โขTreatment is aimed at underlying cause (heart disease, infection).
โขThoracentesis(Pleural Aspiration) is done to remove fluid, collect a specimen,
and relieve dyspnea
19. Therapeutic aspiration:
โข Therapeutic aspiration may be required to palliate breathlessness
โข removing more than 1.5 L at a time is associated with a small risk of
re-expansion pulmonary oedema
