Pleural Effusion (Etiology and Different Varieties)
Mar 01, 2023
Pleural effusion is a common clinical finding with many potential underlying causes. It refers to fluid accumulation in the pleural space between the lung and the chest wall. This condition can result from various underlying conditions, such as heart failure, pneumonia, cancer, tuberculosis, and kidney disease.
Knowledge of pleural effusion is essential for medical professionals as it can be a significant diagnostic and therapeutic challenge.
Fluid is transparent like water and Never Clots in Case of Transudate variety
Thoracocentesis is always done USG guided
>1 cm distance b/w Pleural surface & lung border (i.e. 1 cm of Fluid separating Lung border from Pleural Surface) on CXR is an Indication of Doing Thoracocentesis
Preferred site of Thoracocentesis → 7th ICS (Inter Costal Space) in Scapular line
Different Varieties Of Pleural Effusion
Pleural Effusion related to Malignancy
Usually there is occurs Massive Pleural Effusion in Malignancy (peripherally located cancer)
Leading cause of Malignant Pleural Effusion → Ca Lung (Adenocarcinoma)
Leading cause of Malignant Ascites → Ca Ovary
Symptoms → Pt. C/O TREPEPNEA→ Dyspnea of Patient is Increasing on lateral Decubitus position.
Send the fluid to laboratory to confirm the Exudative variety based on LIGHT’s Criteria
Pleural Fluid Protein
Pleural Fluid LDH
Ideally any 1 of 3 present is sufficient for Diagnosis of Exudative Pleural Effusion.
However, in about 25% of cases light’s criteria may misdiagnose Transudate as Exudate.
Therefore we also check
Pleural fluid Sugar < 60 mg%
Cytology: Microscopic examination : Cancer Cells + nt
Pleural effusion in these cases of Malignancies recurs a lot after Thoracocentesis. To prevent this, we inject a sclerosing agent in pleural space which causes obliteration of pleural cavity and the fluid doesn’t reaccumulate. This procedure is k/as Pleurodesis
Rx: After Removing the fluid from pleural space, give the following drugs:
Injection Doxycycline Into pleural space via chest tube: Leads to formation of Adhesions in various layers of pleura ultimately causing Pleurodesis
Procedure of choice for Mx of patients with Malignant pleural effusion → Pleurodesis
Orthopnea: Breathlessness ↑ing in supine position
Seen in Acute CHF
↑ in Breathlessness in sittingposition
Hepato pulmonary syndrome
If Diagnosed later or failed to Diagnose: Can lead to Empyemawhich then is managed by Chest tube insertion in 5th ICS in Mid Axillary line.
protein > 4.0 g/dL (may exceed 5 g/dL); eosinophils cells (> 10%) or mesothelial cells (>5%) make diagnosis unlikely: see text for additionaldiagnostic tests
Turbid; greenish yellow
1000-20,000 M or P
< 40 mg/dl
Secondary empyema common; high LD, low complement, high rheumatoid factor, cholesterolcrystal areCharacteristic
serous to grossly bloody
1000-50,000 M or P
equal to serum levels
variable findings: no pathognomonicfeatures
turbid to purulent red- brown
< 5000 to50,000 P
high amylase level (salivary origin); pneumothorax in 25% cases; effusion usually on left side: pH< 6.0 strongly suggestsDiagnosis
Turbid to serosanguineous
equal to serum levels
Usually left- sided; highamylase level
GROSS APPEARANCE OF PLEURAL FLUID
A. Haemorrhagic pleural effusion
B. Chylous pleural effusion
c. Transudative Pleural effusion
Chylous Thoracic duct obstruction leads to Chylothorax: This Pleural Fluid isMilky White Colored and has ↑ Triglycerides
Cause of Chylothorax → Damage to lymphatics by Conditions such as Filariasis
To clear all your doubts about this topic and develop a thorough understanding of the same, then download the PrepLadder app. It will give you access to comprehensive video lectures and NEET PG Study material.
Get access to all the essential resources required to ace your medical exam Preparation. Stay updated with the latest news and developments in the medical exam, improve your Medical Exam preparation, and turn your dreams into a reality!