Pleural Effusions: An Overview

1
Pleural Effusions An Overview

• Cheryl DeWitt
• 2/21/06

2
History

• Dyspnea (most common)
• Mild, non-productive cough
• Severe cough with sputum or blood
• Pneumonia vs. bronchial lesion
• Constant chest well pain
• Cancerous invasion of chest wall
• Pleuritic chest pain
• PE vs. inflammatory pleural effusion

3
Physical Exam

• Decreased breath sounds
• Dullness to percussion
• Decreased tactile fremitus
• Pleural friction rub
• Mediastinal shift away from the effusion
• Egophany (E to A)

4
Causes

• CHF
• Malignancy
• Infection
• PE
• Others include hepatic cirrhosis,
  hypoalbuminemia, collagen vascular dz, TB,
  trauma, chylothorax, radiation, or pancreatitis

5
Pathophysiology

• ? Hydrostatic Pressure (e.g. CHF)
• ? Vascular Permeability (e.g. Pneumonia)
• ? Oncotic Pressure (e.g. Nephrotic syndrome
• ? Intrapleural Negative Pressure (e.g.
  atelectasis)
• ? Lymphatic drainage (e.g. mediastinal
  carcinomatosis)
• Cotran, Ramzi, Vinay Kumar, Tucker Collins.
  Robins Pathologic Basis of Disease. Philadelphia
  Elsevier, 1999.

6
Workup

• CXR/CT
• Thoracentesis
• Lab studies on fluids include protein, LDH,
  cytology, cell count, specific gravity, pH,
  amylase, glucose, Grams stain, bacterial/fungal
  cultures
• Plasma LDH and protein
• AFB stain and Cx if TB suspected
• If CV dz suspected, send for RF ANA

7
Treatment

• Treat underlying dz (such as CHF,nephrotic
  syndrome) if transudative fluid
• Exudative fluids treated depending on the disease
  process
• Drain and pleurodese for palliative treatment vs
  chemo if caused by malignancy
• Drain if empyema or causing severe respiratory
  symptoms
• Surgery
• Decortication for thick areas restricting
  breathing
• Drainage of loculated areas
• Pleuroperitoneal shunts for recurrent effusions

8
www.emedicine.com/med/topic1843.htm
9
References

• Ayala, Carlos, and Brad Spellburg.
  Pathophysiology for the Boards and Wards Fourth
  Edition. Malden, Blackwell, 2003.
• Cotran, Ramzi, Vinay Kumar, Tucker Collins.
  Robins Pathologic Basis of Disease. Philadelphia
  Elsevier, 1999.
• www.emedicine.com/med/topic1843.htm