Pleural Effusion

Question 1

Definition of pleural effusion.

Answer 1

A pleural effusion is the abnormal buildup of fluid in the pleural cavity.

Question 2

symptoms of pleural effusion

Answer 2

Dyspnoea
Reduced exercise tolerance
Chest pain

Question 3

signs of pleural effusion

Answer 3

• General inspection: the patient may be in respiratory distress and tachypnoeic.
• The trachea is central or deviated away from the affected side (if large).
• Chest expansion is reduced on the affected side.
• The percussion note is stony dull on the affected side.
• On auscultation there are reduced/absent breath sounds over the effusion. There may be bronchial breathing at the upper border of the pleural effusion.
• Vocal resonance/tactile vocal fremitus is reduced over the effusion.

Question 4

what are the causes of pleural effusions mainly divided into?

Answer 4

exudative (protein content >35 g/L) and transudative (protein content <35 g/L):

Question 5

causes of exudative pleural effusion

Answer 5

Exudative pleural effusions are caused by diseases which increase capillary permeability, including:

• Infections such as pneumonia or TB.
• Malignancy such as bronchial carcinoma, mesothelioma, or lung metastases.
• Inflammatory conditions such as rheumatoid arthritis, lupus, or acute pancreatitis.
• Pulmonary infarct (for example secondary to a pulmonary embolism) and trauma.

Question 6

causes of transudative pleural effusion

Answer 6

Transudative pleural effusions are caused by imbalances in the Starling forces that govern the formation of interstitial fluid.

• Conditions that increase the capillary hydrostatic pressure (forcing fluid out of the pulmonary capillaries into the pleural space) include congestive cardiac failure.
• Conditions that reduce the capillary oncotic pressure (impairing the reabsorption of fluid from the pleural space into the pulmonary capillaries) include cirrhosis, nephrotic syndrome/chronic kidney disease, and gastrointestinal malabsorption/malnutrition (eg. Coeliac disease).

Question 7

investigations in pleural effusion

Answer 7

Routine blood tests
CXR
Diagnostic US-guided thoracentesis for pleural fluid analysis.

Question 8

Management of pleural effusions.

Answer 8

Treat the underlying cause and manage the patient in an ABCDE approach. Use oxygen therapy and medication to reduce respiratory distress. Consider ultrasound-guided pleural aspiration if symptoms persist. Other options include intercostal drain for large effusions, and pleurodesis for recurrent or persistent effusions (chemical or surgical).