Scribd Logo
Upload

Welcome to Scribd!

  • 6 views

    Pleural Effusion 31.10.14

    Uploaded by

    Dr. AHBAB HUSSAIN
    This document discusses pleural effusion, which is an excessive accumulation of fluid in the pleural space between the lungs and chest wall. It covers pleural anatomy, physiology, pathogenesis, clinical features, causes, investigations, and treatment. The key points are that pleural effusion results from an imbalance between fluid production and drainage, and can be caused by conditions affecting the lungs, pleura, or systemic processes. Imaging like chest x-ray and ultrasound are used to diagnose and characterize effusions. Treatment depends on the underlying cause and may involve draining fluid, chemical pleurodesis to prevent reaccumulation, or surgery.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd

    Pleural Effusion 31.10.14

    Uploaded by

    Dr. AHBAB HUSSAIN
    6 views25 pages
    This document discusses pleural effusion, which is an excessive accumulation of fluid in the pleural space between the lungs and chest wall. It covers pleural anatomy, physiology, pathogenesis, clinical features, causes, investigations, and treatment. The key points are that pleural effusion results from an imbalance between fluid production and drainage, and can be caused by conditions affecting the lungs, pleura, or systemic processes. Imaging like chest x-ray and ultrasound are used to diagnose and characterize effusions. Treatment depends on the underlying cause and may involve draining fluid, chemical pleurodesis to prevent reaccumulation, or surgery.

    Copyright

    © © All Rights Reserved

    Available Formats

    PPTX, PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    This document discusses pleural effusion, which is an excessive accumulation of fluid in the pleural space between the lungs and chest wall. It covers pleural anatomy, physiology, pathogenesis, clinical features, causes, investigations, and treatment. The key points are that pleural effusion results from an imbalance between fluid production and drainage, and can be caused by conditions affecting the lungs, pleura, or systemic processes. Imaging like chest x-ray and ultrasound are used to diagnose and characterize effusions. Treatment depends on the underlying cause and may involve draining fluid, chemical pleurodesis to prevent reaccumulation, or surgery.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    6 views25 pages

    Pleural Effusion 31.10.14

    Uploaded by

    Dr. AHBAB HUSSAIN
    This document discusses pleural effusion, which is an excessive accumulation of fluid in the pleural space between the lungs and chest wall. It covers pleural anatomy, physiology, pathogenesis, clinical features, causes, investigations, and treatment. The key points are that pleural effusion results from an imbalance between fluid production and drainage, and can be caused by conditions affecting the lungs, pleura, or systemic processes. Imaging like chest x-ray and ultrasound are used to diagnose and characterize effusions. Treatment depends on the underlying cause and may involve draining fluid, chemical pleurodesis to prevent reaccumulation, or surgery.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 25

    PLEURAL EFFUSION

    Dr. Ahbab Hussain


    Assistant Professor
    Department of Respiratory Medicine
    Learning Objectives
    • Pleural anatomy
    • Physiology
    • Pathogenesis of pleural effusion
    • Clinical features
    • Causes
    • Investigations
    • Treatment
    Introduction
    • Excessive accumulation of pleural fluid in
    pleural space.

    • Imbalance between production and clearance.

    • Pathology can be in lung, pleura or systemic.


    Pleural anatomy
    • The pleura consists of two membranes:
    - Visceral pleura
    - Parietal pleura

    • Pleural space: the potential space between


    parietal and visceral pleura
    • Contains tiny amount of pleural fluid ~0.3
    ml/kg
    • Pleura lines not only the surfaces of the lung
    that are in direct contact with the chest wall
    but also the diaphragmatic and mediastinal
    borders of the lung.
    • Two apposing visceral surfaces form fissures.

    • Lining of the pleurae formed by mesothelial


    cells.
    • On the parietal pleura there are openings in
    the mesothelial cells called as stomata (only
    on parietal pleura).
    •
    • These stomata leads to lymphatic channels,
    allowing passage way for liquid from pleural
    space to the lymphatic system.
    PHYSIOLOGY
    • Pleural space normally contains small amount
    of fluid (10 ml).
    • Formation of fluid is ongoing primarily from
    the parietal pleural surface, and fluid is
    resorbed through the stomata into the
    lymphatic channels of the parietal pleura.
    •
    • Normally rate of formation = absorption.
    PHYSIOLOGY
    • Pleural fluid is the ultra filtrate from the
    pleural capillaries.
    • There are counteracting forces which are
    responsible for transport of fluid, these are
    Hydrostatic pressure –P, and Colloid oncotic
    pressure-COP.
    • ‘P’ promotes movement of fluid out of the
    capillaries and COP prohibits the movement
    from the capillaries.
    PATHOGENESIS
    • A change in the magnitude of any of the
    factors in the Starling equation can cause
    sufficient imbalance in the pleural fluid
    dynamics resulting in pleural fluid
    accumulation.
    PATHOGENESIS
    • There are mainly two categories of change

    1. Alteration of the permeability (i.e. 2. Alteration in the driving pressure,


    change in the filtration coeff K)& encompassing a change in the
    permeability to protein -reflection hydrostatic pressure or COP of the
    coeff. parietal or visceral pleura without any
    change in the permeability.
    Pleura becomes more permeable to
    the fluid and Large mol weight Accumulated fluid  Transudative
    components of blood.

    Changes seen most commonly in CHF


    Accumulated fluid  Exudative or hypoproteinemia.

    Changes seen most commonly in


    inflammatory and neoplastic diseases
    ETIOLOGY
    • Major causes of Pleural effusion
    Transudate:
    • Increased hydrostatic pressure; “overflow
    of liquid from the lung interstitium-CHF
    • Decreased plasma oncotic pressure
    Nephrotic syndrome
    • Movement of transudative ascitic fluid
    through Diaghphram.
    EXUDATE
    Inflammatory
    • Infection (TB, bacterial pneumonia)
    • Pulmonary embolus
    • Connective tissue dis (lupus, RA)
    • Adjacent to subdiaphragmatic diseases (pancreatitis,
    subphrenic abscess)
    Malignant
    Others
    benign ovarian tumors (Meig’s syndrome)
    asbestos exposure
    hypothyroidism
    CLINICAL FEATURES
    SYMPTOMS:
    • Symptoms depend on the size of effusion and
    nature of underlying process.
    • Inflammatory process present with Pleuritic
    chest pain.
    • When effusion is large pt present with dyspnea.
    • Small or moderate size effusion with otherwise
    normal lung does not have dyspnea.
    • If nature is inflammatory or is infected fever is
    commonly present.
    • A h/o cardiac, renal or liver impairment can
    suggest transudative effusion.
    • Old age, wt. loss, and a h/o smoking point
    towards MPE.
    • Trauma may result in hemothorax.
    • Patient presenting with fever, dyspnea and
    pleuritic chest pain up to 03 wks following
    cardiac surgery.
    • History and findings s/o CTD( connective tissue
    disorder)
    CLINICAL FEATURES
    PHYSICAL EXAMINATION:
    • Movement will be diminished, fullness of the
    intercostal space, Trail sign may be +ve on opposite
    side.
    • Trachea, apex beat may be shifted depending on the
    amount of fluid. Vocal fremitus –nt.
    • Region overlying fluid is dull. (dull note)
    • Delayed shifting dullness may be present. Absent in
    massive and loculated effusion.
    • Breathsounds-decreased.
    INVESTIGATIONS: Imaging Studies
    • Chest X-ray
    Chest X-ray

    Classical homogenous opacity with curved upper border, i.e. the Ellis S-
    shaped curve.
    Ultrasonography thorax
    • This helps in detecting even the small amount
    of fluid.
    • USG is helpful in cases of loculated PE for
    confirmation of the diagnosis and for making a
    site for aspiration.
    • Helps in differentiating fluid filled and solid
    lesions.
    • Also helps in detecting subpulmonic effusion
    from sub diaphragmatic collection.
    CT thorax
    • Used to assess the complex situation in which
    anatomy is not fully assessed by plain
    radiography or USG.
    • Helps in selecting drainage site in empyema.
    • Differentiates loculated empyema from lung
    abscess.
    Exudate Vs Transudate
    • Light’s criteria for exudative PE
    – Pleural fluid protein divided by serum protein> 0.5
    – Pleural fluid LDH divided by serum LDH >0.6
    – Pleural fluid LDH more than 2/3rd the upper limit
    of normal serum LDH
    • Sensitivity-98%, specificity-74%
    • A total nucleated cell count of >1000/ml is
    exudate.
    TREATMENT
    • Depend on the nature of underlying cause.
    • Drainage of fluid, pleurodesis and surgical
    management are the therapeutic options for
    pleural effusion.
    THANKS

    You might also like