Pleural effusion def., causes, symptoms, signs and treatment

Definition : It is an abnormal accumulation of fluid in the pleural space.
• In healthy persons, the pleural cavity contains a small volume of lubricating serous fluid formed by transudation from the parietal pleura and absorbed by the capillaries and lymphatics.
 The balance between formation and removal of this fluid may be compromised by any disorder that increases the pulmonary or systemic venous pressure, lowers the plasma oncotic pressure, increases capillary permeability or obstructs the lymphatic circulation.

• A pleural effusion may be transudate that caused by elevated venous pressure or by decreased plasma oncotic pressure, it may be exudate that caused by increased permeability at the pleural surface (due to inflammation, trauma or lung disease) or by obstruction of lymphatics.

Causes of Pleural effusion

Pleural effusion1- Transudate 

 * Heart failure
 * Nephrotic $
 * Liver cirrhosis
 * SVC obstruction
 * Myxedema

2. Exudate

- Lung disease e.g TB-Pneumonia - Malignancy
- Connective tissue disease e.g SLE .
- Sub diaphragmatic abscess
- Pulmonary infarction
- Uremia - pancreatitis (left sided effusion)
- Myxedema .

3- Hemorrhagic
 * Tuberculosis
* Malignancy e.g bronchogenic carcinoma,mesothelioma.


4- Bloody • Haemothorax in chest injuries .

5- Chylous : Obstruction of thoracic duct by tumour, .filariasis.
C/P

Symptoms

• Manifestations of the cause.
• Cough
• Dyspnea if the effusion fluid compresses the lung and interferes with the movement of the diaphragm.
• Dull aching pain, stitching pain if there is active inflammation.

Signs

1- Inspection :  Diminished movement, absent Littin sign.
2- Palpation   :  Trachea shifted to the opposite side       * --- TVF
3- Percussion :  Stony dullness (basal and rising to the axilla )  this may be only observed radiologically .
4- Auscultation :  Diminished intensity of breath sounds.
Egophony is heard over the adjacent compressd lung.

Percussion in pleural effusion:

* Skodiac hyperresonance in upper part of lung above the effusion due to compensatory emphysema.
* Dullness just above the level of effusion due to lung collapse (Grocco's triangle).
* Dullness on the opposite side of effusion (Garland's triangle) due to shift of the mediastinum.
Pleural effusion def., causes, symptoms, signs and treatment
Investigations of pleural effusion : Here

Treatment of pleural effusion

1- Treatment of the cause
2- Aspiration (Thoracentesis):
 To ---  dyspnea
 To  --- incidence of fibrosis es eciall in T.B.
Complications of aspiration are haemothorax, hydropneumothorax and unilateral
pulmonary edema with rapid thoracentesis due to sudden expansion of a collapsed lung.

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