Pleural Effusion
Terms
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- Pleural Effusion
- Pleural effusion is an abnormal accumulation of fluid and is often detectable on plain chest film
- 5 major types of pleural effusion
-
- exudate
- empyema
- transudate
- hemothorax
- chylothorax - Exudate: formed by an active abnormal protein.
-
.5 of pt protein of same pt
.6 LDH of same pt
LDH content 2/3the upper limit
of normal serum - Causes of Exudate
-
Various INFX:
TB, Fungus/parasite
(Pneumo, bact or viral,
Cancer)most common - TRANSUDATE
- Passive movement of fluid
- Resulting from:
-
- increased vascular hydrotstatic pressure
- decreased plasma oncotic pressure
- increased negative intrapleural pressure -
Causes of Transduate:
1.CHF -
accounts for 90% of transudates and is the most common cause of pleural effusion overall. Left ventricular failure causes pressure to increase in the pulmonary vessels ----->
increased hydrostatic pressure.
REMINDER:CHF s a syndrome
which results from one or more of the various causes of heart pathology,
i.e. cardiomyopathy, valvular disease, infarction - 2.Nephrotic Syndrome
- decreased plasma oncotic pressure
- 3.Constrictive pericarditis
- noncompliant pericardium restricts ventricular filling and mimics CHF
- 4.Acute atelectasis
-
increased negative intrapleural pressure
- Pulmonary embolism ïƒ inc’d Pul.Vasc. Resistance ïƒ inc’d hydro-
static pressure ïƒ transudate - EMPYEMA
- a form of exudate. Fluid is turbid or purulent due to infection in the pleural space itself.
- HEMOTHORAX
- gross blood in pleural space. Usually due to chest trauma.
- CHYLOTHORAX
- milky in appearance due to presence of cholesterol complexes.most common in tuberculous pleuritis or rheumatoid
- S&S
-
pleuritic chest pain (pain with breathing not due to fractured rib) effusion is usually exudative.
if pleural friction rub -> indicates pleurisy.
SMALL EFFUSIONS:usually asymptomatic.
LARGE EFFUSIONS: dyspnea,
may compress.
dullness to percussion lung.
dullness to percussion.
Massive effusion on one side may push the trachea(and therefore the tracheal air column)to the opposite side. - X-RAY FINDINGS:
-
blunting of the costophrenic sulcus (or angle ) due to fluid accumulation there.
“Thickening†of interlobal and/or interlobular lung fissures on plain film.
Crescentic line or meniscus: When an effusion is large enough, it fills the pleural space from the lung base toward the lung apex, so the affected hemithorax appears as a large white opacification on the Xray