Pleural effusion

Pleural effusion

• 1.
  PLEURAL EFFUSION
• 2.
  • Pleural effusion,a collection of fluid in the pleural space, is rarely a primary disease process but is usually secondary to other diseases. Normally, the pleural space contains a small amount of fluid (5 to 15 mL), which acts as a lubricant that allows the pleural surfaces to move without friction.
• 3.
  Physiology • Normally pleuralspace contains a thin layer of fluid. • Fluid enters the pleural space from the capillaries in the parietal pleural and is removed by the lymphatics in the parietal pleura. • Fluid can also enter the pleural space from the interstitial spaces of the lung via the visceral pleura or from the peritoneal cavity through the diaphragm.
• 4.
  PATHOPHYSIOLOGY • Pleural fluidaccumulates when Formation increases Absorption decreases • Pleural effusion can be Transudative Exudative
• 5.
  • Transudative effusionoccurs commonly due to systemic factors which either increase the hydrostatic pressure or decrease the plasma oncotic pressure. • Exudative effusion occurs due to local pathology in the lung or the pleura.
• 6.
  ETIOLOGY • Transudative pleuraleffusion • Congestive cardiac failure • Cirrhosis • Pulmonary embolism • Nephrotic syndrome • Peritoneal dialysis • Myxoedema
• 7.
  Exudative Pleural Effusion •Neoplastic diseases • Metastatic diseases • Mesothelioma • Infectious diseases • Pneumonia • Tuberculosis • Gastrointestinal diseases • Pancreatic disease • Esophageal perforation • Intraabdominal abscess • Diaphragmatic hernia
• 8.
  Exudative Pleural Effusion •Collagen vascular diseases • Rheumatoid arthritis • SLE • Drug-induced lupus • Immunoblastic lymphadenopathy • Sjogrens syndrome • Asbestos exposure • Sarcoidosis
• 9.
  Clinical Features Symptoms • Chestpain (pleurisy) • Breathlessness • Symptoms associated with the actual cause of pleural effusion • Pnemonia • Renal disorder, Cardiac and liver disease • TB • Risk for thromboembolism • Exposure to asbestos (occupation)
• 10.
  Signs • Trachea shiftedto opposite side • Chest movements decreased • Stony dullness • Absent breath sounds. • crackles may be present. • Decreased vocal resonance and fremitus on same side
• 11.
  DIAGNOSIS • Chest Xray • CT scan • Thoracentesis • Pleural fluid is analyzed by bacterial culture, Gram stain, acidfast bacillus stain (for TB), red and white blood cell counts, chemistry studies (glucose, amylase, lactic dehydrogenase, protein), cytologic analysis for malignant cells, and pH. • A pleural biopsy also may be performed
• 12.
  MANAGEMENT OF PLEURAL EFFUSION Treatmentof underlying cause Therapeutic aspiration/thoracentesis is necessary in order to relieve dyspnoea Precautions: Removing more than 1L in one episode in inadvisable Can result in re-expansion pulmonary oedema Should never be aspirated to dryness before the exact etiology is determined
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  COMPLICATIONS OF THORACENTESIS Iatrogenicpneumothorax Infection Dry tap or bloody tap Re-expansion pulmonary oedema Pain and respiratory distress
• 14.
  • Other treatmentsfor malignant pleural effusions include • surgical pleurectomy, • insertion of a small catheter attached to a drainage bottle for outpatient management, or • implantation of a pleuroperitoneal shunt.