Pleural Effusion Clinical symptoms and sign - Dr. Sheetu Singh (1)

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Loculated Effusion

• Pleural fluid may become encapsulated by
  adhesions anywhere between the parietal and the
  visceral pleura or in the interlobar fissures.
• Associated with conditions that cause intense
  pleural inflammation, such as empyema,
  hemothorax, or tuberculous pleuritis.
• Loculation are typically D-shaped, with the base
  of the D against the chest wall and the smooth
  convexity protruding inward toward the lung
  because of the compressibility of the lung
  parenchyma.
• Loculation may be differentiated from parenchymal
  infiltrates by the absence of air bronchograms.
• A definitive diagnosis of loculated pleural
  effusion is best established by ultrasound.

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Loculated pleural effusion
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Air fluid level

• Hydropneumothorax / pyopneumothorax
• Lung abscess
• Cyst with fluid level

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Clinical symptoms

• Chest pain pleuritic, dull-aching
• Cough dry
• Dyspnoea compression of lung, decreased venous
  return ? decreased cardiac output, inversion of
  diaphragm

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Signs

• Inspection
• Respiratory rate may be increased
• Intercostal spaces may be bulging
• Respiratory movement on affected side may be
  reduced
• Palpation
• Tactile vocal fremitus decreased on affected side
• Percussion
• Stony dull note
• Shifting dullness present
• Auscultation
• Reduced air entry