Pleural Effusion

Pleural Effusion-Definition it is an abnormal collection of fluid in the pleural space resulting from excess fluid production or decreased absorption. It is the most common manifestation of pleural disease, with etiologies ranging from cardiopulmonary disorders to symptomatic inflammatory or malignant diseases.

Pleural Effusion The prevalence of pleural effusion is slightly in excess of 400/100 000 population. Approximately 1.5 million pleural effusions are diagnosed in the United States each year.

Pleural Effusion-Causes Transudative Exudative Unilateral Bilateral

Transudative Causes Conditions associated with transudative pleural effusions: Congestive Heart Failure (CHF) Hepatic cirrhosis Hypoproteinemia Nephrotic syndrome Acute atelectasis Myxedema Peritoneal dialysis Meig's syndrome Obstructive uropathy

Exudative causes Conditions associated with exudative pleural effusions: Malignancy Infection Trauma Pulmonary infarction Pulmonary embolism Autoimmune disorders Pancreatitis Rheumatoid Pleurisy Drug-induced Lupus Tuberculosis

Pleural Effusion-Pathophysiology

Pleural Effusion-Diagnosis History Physical Examination X-ray Chest Ultrasonography CT Scan Thoracocentesis (Diagnostic) Pleural Biopsy

Pleural Effusion-History Dyspnea Cough Chest pain Weakness Fever Weight loss Hemoptysis History of trauma, cardiac surgery, cancers

Pleural Effusion-Physical Examination Clinically detectable when more than 500 ml Inspection Palpation Chest expansion and excursion Tactile fremitus Percussion Auscultation Breath sounds Vocal fremitus

Pleural Effusion- Xray Chest

Peural effusion Ultrasonography & Tomography

Pleural Effusion Diagnostic Thoracocentesis

Pleural Effusion Diagnostic Thoracocentesis Colour and gross appearance

Pleural Effusion Diagnostic Thoracocentesis Colour Biochemical Analysis Protein Glucose LDH Microbiology Gram Staining ZN Staining

Pleural Effusion Diagnostic Thoracocentesis Cytology TLC DLC Malignant cytology Culture & Sensitivity Bacterial Mycobacterial Fungal

Pleural Biopsy

Pleural Effusion-Treatment Treat the cause Diuretics Antibiotics Albumin Corticosteroids Anti-inflammatory agents Immunosuppressants

Treat the cause Malignancy Infection Trauma Pulmonary infarction & Embolism Pancreatitis Rheumatoid Pleurisy Tuberculosis

Treat the cause Congestive Heart Failure (CHF) Cirrhosis Hypoproteinemia Nephrotic syndrome Myxedema

Thoracocentesis From Greek, thorax + centesis, puncture) also known as pleural tap, It is an invasive procedure to remove fluid or air from the pleural space for diagnostic or therapeutic purposes. A cannula, or hollow needle, is carefully introduced into the thorax, generally after administration of local anesthesia. The procedure was first described in 1852. The recommended location varies. midaxillary line, in the eighth, ninth, or tenth intercostal space. Whenever possible, the procedure should be performed under ultrasound guidance, which has shown to reduce complications.

Therapeutic Thoracocentesis

Therapeutic Thoracocentesis

Precautions-thoracocentesis Pain free Proper position and posture Selection of exact location to be punctured Bleeding profile Amount of fluid to be taken out Post procedure precautions

Thoracocentesis Contraindications An uncooperative patient Coagulation disorder Relative contraindications include cases in which the site of insertion has known emphysema Patient is on  mechanical ventilation Only one functioning lung 

Thoracocentesis Complications Pneumothorax Hemothorax Hemopneumothorax Hypotension Pulmonary edema Minor complications include: A dry tap (no fluid return) Subcutaneous hematoma or seroma Anxiety,  Dyspnea and cough The use of ultrasound for needle guidance can minimize the complication rate.