Pleural Effusion definition , pathology, cause, clinical feature, investigation, management

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Pleural Effusion definition , pathology, cause, clinical feature, investigation, management

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#Pleural effusion

The accumulation of serous fluid within the
pleural space is called pleural effusion!

accumulation of  frank pus termed as empyema.
accumulation of blood termed as haemothorax.
accumulation of chyle termed as chylothorax.

#Pathology:
Covering of the lungs is called pleura. Pleura has two layers: parietal pleura & visceral pleura. Fluid accumulates in between parietal pleura & visceral pleura. Pleural fluid accumulates as a result of either increased hydrostatic pressure or decreased osmotic pressure within the microvasculature of the pleura.

#Causes of pleural effusion:
(common causes)
pneumonia
tuberculosis
pulmonary infraction
cardiac disease
subphrenic abscess
pancreatitis
malignant disease

(uncommon causes)
nephrotic syndrome
Liver failure
systemic lupus erythrematous
acute rheumatic fever
meigs syndrome (ovarian tumor , ascites, pleural effusion)


#Clinical features:

Breathlessness
Chest pain
Signs of pleurisy
On auscultation: Pleural rub may be present !
(pleural rub is a frictional sound produced during inspiration)


#Investigation:
Chest X ray:
(Obliteration of costophrenic angle. Curved shadow & homogenous opacity at the lung base. Around 200 ml of fluid is required to detect on PA chest x ray.)

Ultrasonogram:
More accurately detect pleural fluid.

Pleural fluid aspiration & biopsy.


#Management:

Therapeutic aspiration may be required, aspirate more than 1.5L at a time causes re-expansion of pulmonary oedema.

Treatment of the underlying cause.

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