PLEURAL EFFUSION

PLEURAL EFFUSION
A pleural effusion may develop when
their is excess pleural fluid formation
( from the interstitial spaces of the lungs,
the parietal pleura, or the peritoneal
cavity) or when their is decreased fluid
removal by the lymphatics

Harrisons Principles of Internal Medicine 17 th Edition

PLEURAL EFFUSION
Transudative and Exudative pleural effusion
are distinguished by measuring the LDH
and protein level in the pleural fluid.
Exudative fluid meet at least one of this
criteria:
a. Pleural fluid protein serum/serum protein >0.5
b. Pleural fluid LDH/serum LDH >0.6
c. Pleural fluid LDH more than two-thirds normal
upper limit for serum.
Harrisons Principles of Internal Medicine 17th
Edition

PLEURAL EFFUSION

TRANSUDATIVE

Systemic factors influence

the
formation and
absorption rate of pleural fluid
are altered
CHF, CIRRHOSIS,
NEPHROSIS

EXUDATIVE

Local factors influence the

formation and absorption rate
of pleural fluid are altered
BACTERIAL PNEUMONIA,
MALIGNANCY, VIRAL
INFECTION, PULMONARY

TRANSUDATIVE EFFUSION
EFFUSION DUE TO
HEART FAILURE
common cause:
left sided heart
failure

Blood will not be pumped

out effectively from the
heart

Blood will pool back to the

LEFT ATRIUM

PULMONARY VEIN

HYDROSTATIC
PRESSURE

TRANSUDATIVE EFFUSION
Cirrhosis
Hepatic
Hydrothorax
Nephrosis

ONCOTIC
PRESSURE

PARAPNEUMONIC EFFUSION
Associated with bacteral pneumonia,
lung abscess or bronchoectasis and
are probably the most common
cause of exudative pleural effusion

Harrisons Principles of Internal Medicine

17th Edition

PARAPNEUMONIC EFFUSION

PARAPNEUMONIC EFFUSION
Patients with bacterial pneumonia +
Pleural effusion usually presents
with:
Acute febrile illness
Chest pain
Sputum production
leukocytosis