Fluid accumulation in pleural space.
- Patients present with shortness of breath and cough.
- Can be asymptomatic and recognized on routine CXR.
- Dullness with decreased breath sounds and mediastinal shift can be seen.
- Chest x-ray shows fluid in pleural space with classical meniscus. Additional
findings will depend on the etiology.
Multiple etiologies can give rise to pleural effusion. Following are the common.
- Congestive heart failure
- Rheumatoid arthritis
Mechanisms leading to accumulation of fluid in pleural spaces vary. Following
- Increased hydrostatic pressure eg CHF.
- Increased capillary permeability eg malignancy
- Direct extravasation eg Chylothorax
- Negative pressure induced eg trapped lung
- Pleural effusions are categorized as exudates and transudates.
- Thoracentesis is essential to obtain fluid for appropriate studies based on the
- Malignancy is the most common cause of exudative effusions and should be ruled
out with cytological exam.
- In undiagnosed effusions one have to consider pleural biopsy either by blind
method or by thoracoscopy.
- Appropriate specific therapy based on the etiology.
- Therapeutic thoracentesis may be required to relieve shortness of breath.
- Pleural sclerosis will be a consideration in malignant effusions to prevent
Details taught during mechanisms of disease course.