466841108-1-pleural-effusion-ppt.ppt.....

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1. Pleural effusion

2. Definition
Is defined as accumulation of serous fluid in
pleural space or pleural cavity.
-accumulation of pus in pleural cavity is called
empyema.
-accumulation of blood in pleural space is
called haemo thorax.
-accumulation of chyle in pleural space is
called chylo thorax.

3. TYPES OF PLEURAL EFFUSION
1.UNILATERAL PLEURAL EFFUSION:
Causes: pneumonia,tuberculosis, malignancies,
pancreatitis, meig’s syndrome,pulmonary
embolism
1.BILATERAL PLEURAL EFFUSION:
Causes:congestive cardiac failure,cirrhosis of liver,
nephrotic syndrome,collagen vascular diseases,
bilateral TB, bilateral pneumonia

4. Types of pleural fluid:
1.Exudative fluid
2.Transudative fluid

5. Difference between exudativeand
transudativefluid:
-Pleural fluid protein/ TRANSUDATIVE EXUDATIVE
Serum protein <0.5 >0.5
-Pleural fluid LDH/
Serum LDH <0.6 >0.6
-pleural fluid LDH >2/3
rd <2/3rd of upper
of upper limit of limit of serum
serum
-fluid gradient >3.1g/dl <3.1g/dl
-colour clear serous turbid
-on shaking no froth froth

6. 19.14 Causes of pleural effusion
TRANSUDATIVEFLUID CAUSES:
1.CARDIAC FAILURE
2.NEPHROTIC SYNDROME
3.CIRROHIS OF LIVER (LIVER FAILURE)
4.HYPOPROTEINAEMIA
5. MYXOEDEMA
EXUDATIVE FLUID CAUSES:
1. PNEUMONIA
2. TUBERCULOSIS
3.MALIGNANCY
4.PULMORYINFARCTION
5.ACUTE PANCREATITIS
6. COLLAGENVASCULAR DISEASE

7. PATHOLOGY:
•Pleural fluid accumulates when pleural fluid formation exceeds
Pleural fluid absorption. Normally, fluid enters the pleural space from the
capillaries in the parietal pleura and is removed via the lymphaticssituated
in the parietal pleura. Fluid can also enter the pleural space from the
interstitial spaces
of the lung via the visceral pleura or from the peritoneal
cavity via small holes in the diaphragm. The lymphaticshave the capacity
to absorb 20 times more fluid than is normally formed. Accordingly, a
pleural effusion may develop when there is excess pleural fluid formation
(from the interstitial spaces of the lung, the parietal pleura, or the peritoneal
cavity) or when there is decreased fluid removal by the lymphatics

8. CLINICAL FEATURES:
SYMPTOMS: SIGNS:
•Chest pain before effusion -dyspnoeic
•Breathlessness -use of accesory
•Dry cough muscle
•h/o of fever -cyanosis
•Anorexia -clubbing
•Weight loss -lymphadenopathy
•Haemptysis
•Features of underlying
disease:CCF,liver failure
Nephrotic syndrome

9. On chest examination
•Inspection:reduced chestwall movement on
affected side, fullness of intercoastals on affected
side
. palpation: decrease chest expansion , decrease
vocal fremitus
•Percussion: stony dull
•Auscultation: decrease or absent breath sound,
decrease or absent vocal resonance,crepitations

10. INVESTIGATIONS:
•Complete blood count:blood TC DC,HB%
•Chest x-ray (PA view):obliteration of costophrenic
angle or cardiophrenic angle
•Sputum for gram stain,culture,AFB and malignant
cells, mantoux test
•Pleural aspiration and biopsy: Pathological test for
predominant cells(TC, DC) biochemical test(pleural
fluid protein ,LDH,albumin ADA for TB)and
microbiological test(isolation of any organism)
•CT scan of chest
•Investigations according to cause of disease

11. Differential diagnosis
DISEASE APPEARANCE TYPE OF FLUIDPREDOMINANT
CELLS
OTHER
DIAGNOSTIC
FEATURES:
CARDIAC FAILURESTRAW COLOR TRANSUDATE SEROSAL CELLSOTHER EVIDENCE
OF LEFT HEART
FAILURE AND
RESPONSETO
DIURETICS
TUBERCULOSIS AMBER COLOR EXUDATE LYMPHOCYTES POSITIVE
TUBERCULIN
TEST AND +VE
CHEST XRAY AND
ISOLATION OF
M.TUBERCULOSIS
MALIGNANT
DISEASE
SEROUS OFTEN
BLOOD STAINED
EXUDATE MALIGNANT
CELLS
EVIDENCE OF
MALIGNANT
DISEASE
ELSEWHERE

12. treatment
1. General measures: bed rest,propped up position
,oxygen inhalation, symptomatic support,
•Pleurocentesis: removal of fluid from pleural space
•Chest tube drainage for empyema
2.Specificic treatment:if TB-antituberculae drugs
if pneumonia: aspiration followed by antibiotics
If malignant effusion: intercoastal chesttube drainage
followed by closure of pleural space by
chemical/surgical procedure and CHEMOTHERAPY
3. Treatment of other conditions:congestive cardiac
failure , nephrotic syndrome

13. complications
•Empyema thoracis
•Pneumothorax
•Haemothorax
•Renal failure
•Cardiorespiratory distress

14. CHEST X-RAY
A homogenous opacification is noted in the right lower zone with the opacity seen to
track along the lateral chest wall. The right costophrenic angle is obliterated with a
meniscus noted. Findings are suggestive of a right sided pleural effusion.