PLEURAL EFFUSION ( Definition, Types , clinical feature, cause , investigation, differential diagnosis and treatment)

PLEURAL EFFUSION IN LEFT SIDE ( UNILATERAL)

 PLEURAL EFFUSION

-Pleural effusion is the abnormal buildup of fluid in the pleural space, the area between the lung and the chest wall.

TYPES OF PLEURAL EFFUSION :

A. According to the fluid;

1.Chylothorax:

 - is a rare but serious condition in which lymph formed in the digestive system (chyle) accumulates in your chest cavity.

2.Hemothorax;

 -is a collection of blood in the space between the chest wall and the lung (the pleural cavity).

3.Hydrothorax;

- Hydrothorax is a noninflammatory collection of serous fluid within the pleural cavities. The effusion is clear and straw colored.

-it is the most common type of pleural fluid.

4.Pyothorax;

-collection of pus in pleural space.

B.Aetiological type;

1.Transudative

2.Exudative

1. Transudative( common type)

-Transudative pleural effusion is caused by fluid leaking into the pleural space.

- This is from increased pressure in the blood vessels or a low blood protein count. --Heart failure is the most common cause.

-Transudates are usually caused by increased systemic or pulmonary capillary pressure and decreased osmotic pressure, resulting in increased filtration and decreased absorption of pleural fluid.

-Major causes are;

 .Cirrhosis, 

Congestive heart failure,

 Nephrotic syndrome,

 Protein-losing enteropathy, 

Certain medications, such as diuretics, can also cause a transudative pleural effusion.

2.Exudative pleural effusion:

Exudative pleural effusions generally are caused by infections such as-

 Pneumonia, 

Malignancy, 

Granulomatous diseases such as- tuberculosis or coccidioidomycosis, collagen vascular diseases, and other inflammatory states.

C. According to site: 

1. Unilateral pleural effusion ( one side of chest)

- mostly seen in right side of chest . 

2. Bilateral pleural effusion ( both)

CAUSE OF PLEURAL EFFUSION;

Heart failure: When the heart is not able to pump blood effectively, fluid can back up into the lungs and the pleural space.

Lung infection: Pneumonia, tuberculosis, and other lung infections can cause inflammation and fluid accumulation in the pleural space.

Cancer: Tumors in the lung or pleural space can cause fluid to accumulate.

Kidney failure: When the kidneys are not able to remove fluid from the body, it can build up in the pleural space.

Liver disease: Cirrhosis and other liver diseases can cause fluid to accumulate in the abdomen, which can then travel to the pleural space.

Other causes: Certain medications, blood clots in the lungs, and trauma to the chest can also cause pleural effusion

CLINICAL FEATURE;

Shortness of breath

Pleuritic Chest pain or discomfort

Cough- Dry cough

Fatigue

Rapid breathing

Rapid heartbeat

Low blood pressure

Rapid breathing

Decreased breath sounds on one side of the chest.

 Orthopnea

Cyanosis

Clubbing

Lymphadenopathy

Inspection -

1.  Dyspneaic

2 .  Site of intercostal space is distended

Palpation;

1. Decrease the tactile vocal fremitus.

2. If unilateral effusion -mediastinal fluid shifting in opposite side. 

3.Decreased chest expansion in affect side. 

Percussion:

1.In a patient with pleural effusion, the chest will sound dull or "muted" when tapped or percussed, as the fluid in the pleural cavity dampens the sound waves.

Auscultation;

-Decreased breath sounds on one side of the chest.

- Decrease the vocal resonance.

INVESTIGATION OF PLEURAL EFFUSION:

The investigation of pleural effusion typically begins with a physical examination and

1. Chest X-ray;-

The tests most commonly used to diagnose and evaluate pleural effusion include: Chest x-ray. 

_(-Increased homogeneous density superimposed over the lung fields, obliteration of the silhouette of the diaphragm, meniscus sign, apical capping, and accentuation of the right minor fissure.

which can help to identify the presence of fluid in the pleural space.)

 2.Additional tests, such as a CT scan or ultrasound,

- may be used to further evaluate the fluid and determine the cause.

3.If the cause of the pleural effusion is not immediately clear, a sample of the fluid may be removed through a procedure called thoracentesis. 

The fluid can then be analyzed for various characteristics such as the-;

 protein content, glucose level, and cell count.

 These characteristics can help to differentiate different types of pleural effusions.

( INVESTIGATION according to causes)-

-ECG, ECHO, 

4. Blood test, - RFT , LFT , CBC, HB% 

5.Sputum test- AFB , C/S 

6.Urine test - R/E 

DIFFRENTIAL DIAGNOSIS;-

Lung cancer

Pneumonia

Congestive heart failure

Pulmonary embolism

Rheumatoid arthritis

Liver disease

Kidney failure

Tuberculosis

Lymphoma

Sarcoidosis etc.. 

 

MANAGEMENT 

Pleural Effusion Treatment plan;-

Treatment for pleural effusion typically depends on the underlying cause of the condition. Common treatments include:

Drainage of fluid: A procedure called thoracentesis is used to remove excess fluid from the pleural space using a needle or small tube.

Thoracocentesis is a procedure in which a needle is inserted through the chest wall to remove fluid from the pleural space. This procedure is typically performed to alleviate symptoms of pleural effusion,

Medications:

 Diuretics, such as furosemide, may be prescribed to reduce the production of fluid in the pleural space. In addition, antibiotics may be prescribed to treat or prevent infection.

Surgery: In some cases, surgery may be necessary to remove a tumor or repair a damaged lung, which can lead to pleural effusion.

Thoracoscopy: A thoracoscope is inserted into the pleural space through a small incision in the chest wall, allowing the doctor to view the pleural space and remove any abnormal tissue.

Pleurodesis: A procedure that uses chemicals or talc to create adhesions, which causes the pleural layers to stick together and prevent fluid from building up.

Radiation therapy: May be used to shrink tumors that are causing pleural effusion and to reduce the risk of fluid reaccumulation.

It's important to note that the treatment plan will depend on the specific cause of the pleural effusion. Your physician will recommend the best course of treatment for you.

COMPLICATION OF PLEURAL EFFUSION

1. Pneumothorax ( most common complication)

2. Lung collapse

3.Infection - Lung abscess, Empyema , Sepsis

4.Respiratory failure

5.Pulmonary oedema

6. Cardiovascular distress

7.Renal failure