1. Pleural Effusion

3. 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.

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

6. Pleural Effusion-Causes
Transudative
Exudative
Unilateral
Bilateral

7. 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

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

9. Pleural Effusion-Pathophysiology

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

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

13. 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

14. Pleural Effusion- Xray Chest

20. Peural effusion Ultrasonography & Tomography

21. Pleural Effusion Diagnostic Thoracocentesis

22. Pleural Effusion Diagnostic Thoracocentesis
Colour and gross appearance

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

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

28. Pleural Biopsy

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

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

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

32. 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.

33. Therapeutic Thoracocentesis

34. Therapeutic Thoracocentesis

35. 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

36. 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 

37. 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.