Pleural Effusion

Last updated 20.09.12

 

Definition

-  Fluid accumulation in the pleural cavity

-  Hydrothorax: serous fluid

-  Haemothorax: blood

-  Chylothorax: lymph

-  Empyema (pyothorax): pus

 

Associated S/S

-  Dyspnoea

-  Cough

-  Pleuritic chest pain

-  Hoover sign: decreased chest expansion on effected side

-  Dullness to percussion over effusion

-  Decreased breath sound over effusion

-  Decreased vocal resonance & tactile fremitus

-  Egophany at superior aspect of effusion

-  Pleural friction rub

-  Tracheal deviation: large effusion

-  S/S of underlying cause

 

Causes

-  Bacterial pneumonia (30-40% develop effusion), TB, fungal or viral infections

-  AID: RA, SLE

-  Cancer: breast, lung, lymphoma, mesothelioma

-  Left ventricular failure: CCF, APO

-  PE

-  Cirrhosis

-  Oesophageal rupture

-  Pancreatitis: right sided

-  Lympatic trauma: surgery, MVA

-  Bleeding: trauma

-  Uraemia

-  Peritoneal dialysis

 

Ix

-  CXR

-  Blunting of costophrenic angels

-  AP requires 250-500 ml

-  Lateral requires 175-200 ml

-  Meniscus sign: upwardly concave

-  Unilateral vs bilateral: causes as above

 

 

 

 

-  US: blood vs seruos, +/- debris

-  Thoracentesis (pleural tap)

-  Exudate

-  Bacterial pneumonia, cancer, viral infection

-  Transudate

-  Left ventricular failure, PE, cirrhosis

 

 

 

References