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Pleural effusion
Pleural effusion is the presence of fluid
within the pleural space, the pleural can be
the site of both benign and malignant
diseases that may represent primary pleural
processes, localized extrapleural diseases,
or systemic illnesses. Pain and dyspnea are
the most common symptoms of pleural
disease.
Anatomy of pleural membrane
and pleural space 1234
Permeability
of systemic Permeability of pleural 34
circulation(34) fluid (8)
5+8+30-34=9 34-(5+8+11)=10
The mechanisms that lead to accumulation
of pleural fluid
l. Increased hydrostatic pressure in microvascular
circulation (congestive heart failure)
2. Decreased colloidal osmotic pressure in microvascular
circulation (severe hypoalbuminemia )
3. Increased permeability of the microvascular circulation
(pneumonia)
4. Decrease in the intrapleural pressure
5. Impaired lymphatic drainage from the pleural
space (malignant effusion)
6. Movement of fluid from peritoneal space ( ascites )
7.Rupture of a vascular or lymphatic structure (trauma,
cancer)
Transudates and exudates
flowing
Hemothorax
l. Trauma
2. Tumor
3. Pulmonary infarction
4. TB
5. Spontaneous pneumothorax
Chylous effusion
1. Trauma
2. Tumor
3. TB
4. Thrombosis of the left subclavian vein
Bilateral effusion
1. Generalized salt and water
retention
e.g., congestive heart failure
nephrotic syndrome
2. Ascites
3. Pulmonary infarction
4. Tumor
5. TB
♦ T B ( Tuberculosis ) is the most
common cause of pleural effusion ,
especially in young people
♦ Malignant pleural effusion is frequently
met in aged people today
♦ Pleural transudation is most commonly
caused by congestive heart failure
Diagnostic procedures 12345
History(primary diseases)
clinical signs
physical examinations
clinical signs
♦ pleural pain,
♦ dyspnea,
♦ tachypnea,
♦ mild outward bulging of the intercostal
spaces,
♦ decreased tactile fremitus,
♦ dullness or flatness,
♦ decreased transmission of breath and vocal
sounds in the area of the effusion,
♦ and occasionally pleural friction sound in its
early stage (dry pleurisy)
Diagnostic procedures 12345
Chest X-ray examination
Blunting of the normally sharp costophyrenic
angle, a concave shadow with its highest margin
along the pleural surface, shift of the mediastinum
and the trachus toward the normal side
Pleural effusion
Diagnostic procedures 12345
Ultrasonic examination
To localize a small pleural effusion and
determine the correct site for performance
of a thoracentesis
Diagnostic procedures 12345
Thoracentesis
To aspirate the effusion for laboratory
examination:
Appearance, Specific gravity, Protein content,
Cell counts, Glucose, LDH lipid content,
Rheumatoid factor (RF),
Gram stain and culture,
Cytologic examination, etc.
Diagnostic procedures 12345
Pleural biopsy
To obtain a specimen for histologic
examination and culture
Diagnostic procedure
is there pleural effusion or not ?
Thoracentesis
transudates? exsudates?
what is the etiology?
reveals lymphocytosis
Rarely pleural fluid is blood stained
The PPD or OT test usually positive
Diagnosis