Pleural effusion occurs when fluid accumulates in the pleural space, usually due to other underlying diseases or conditions that cause an imbalance between fluid formation and absorption. Normally a small amount of fluid is present to reduce friction between the pleural layers. Pleural effusions can be transudative or exudative, with transudative caused by systemic factors altering hydrostatic or oncotic pressures and exudative caused by local lung or pleural pathology. Diagnosis involves chest imaging and thoracentesis to analyze pleural fluid. Treatment focuses on the underlying cause, with thoracentesis used to relieve symptoms but risks like pneumothorax needing to be managed.

1. PLEURAL EFFUSION

2. • Pleural effusion, a collection of fluid in the pleural
space, is rarely a primary disease process but is
usually secondary to other diseases. Normally, the
pleural space contains a small amount of fluid (5 to
15 mL), which acts as a lubricant that allows the
pleural surfaces to move without friction.

3. 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.

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

5. • 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.

6. ETIOLOGY
• Transudative pleural effusion
• Congestive cardiac failure
• Cirrhosis
• Pulmonary embolism
• Nephrotic syndrome
• Peritoneal dialysis
• Myxoedema

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

8. Exudative Pleural Effusion
• Collagen vascular diseases
• Rheumatoid arthritis
• SLE
• Drug-induced lupus
• Immunoblastic lymphadenopathy
• Sjogrens syndrome
• Asbestos exposure
• Sarcoidosis

9. Clinical Features
Symptoms
• Chest pain (pleurisy)
• Breathlessness
• Symptoms associated with the actual cause of pleural
effusion
• Pnemonia
• Renal disorder, Cardiac and liver disease
• TB
• Risk for thromboembolism
• Exposure to asbestos (occupation)

10. Signs
• Trachea shifted to opposite side
• Chest movements decreased
• Stony dullness
• Absent breath sounds.
• crackles may be present.
• Decreased vocal resonance and fremitus on same side

11. DIAGNOSIS
• Chest X ray
• CT scan
• Thoracentesis
• Pleural fluid is analyzed by bacterial culture, Gram
stain, acidfast bacillus stain (for TB), red and white
blood cell counts, chemistry studies (glucose,
amylase, lactic dehydrogenase, protein), cytologic
analysis for malignant cells, and pH.
• A pleural biopsy also may be performed

12. MANAGEMENT OF PLEURAL
EFFUSION
Treatment of underlying cause
Therapeutic aspiration/thoracentesis is necessary
in order to relieve dyspnoea
Precautions:
Removing more than 1L in one episode in inadvisable
Can result in re-expansion pulmonary oedema
Should never be aspirated to dryness before the exact
etiology is determined

13. COMPLICATIONS OF THORACENTESIS
Iatrogenic pneumothorax
Infection
Dry tap or bloody tap
Re-expansion pulmonary oedema
Pain and respiratory distress

14. • Other treatments for malignant pleural effusions
include
• surgical pleurectomy,
• insertion of a small catheter attached to a drainage
bottle for outpatient management, or
• implantation of a pleuroperitoneal shunt.