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 causesConditions 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 edemaMinor 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.