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https://upload.medbullets.com/topic/117039/images/pleural effusion.jpg
https://upload.medbullets.com/topic/117039/images/pleural_effusion.jpg
Introduction
  • Pathologic accumulation of fluid in the pleural space  often parapneumonic (in association with pneumonia) 
    • if infected, known as an empyema
  • Effusions classified by pathogenesis 
    • transudative
      • occur secondary to ↑ pulmonary capillary pressure or ↓ capillary oncotic pressure
    • exudative
      • occur secondary to increased pleural vascular permeability
Presentation
  • Symptoms
    • often asymptomatic
    • may present with dyspnea
    • pleuritic chest pain
    • cough
  • Physical examination
    • decreased breath sounds
    • dullness to percussion
    • decreased tactile fremitus
      • versus consolidation, which produces increased tactile fremitus
Evaluation
  • CXR
    • shows blunting of the costophrenic angles
    • layering on decubitus film if free flowing
  • Thoracentesis
    • diagnostic gold standard
    • indicated for new effusions
  • Fluid Studies 
    • Light's criteria: exudative if any 1 of 3 present  
      • ratio of fluid protein to serum protein > 0.5
      • ratio of fluid LDH to serum LDH > 0.6
      • fluid LDH > 2/3 upper limit of normal for serum
    • Other common studies to help identify etiology and guide treatment
      • glucose
      • pH
      • amylase
      • triglycerides
      • Gram stain, culture
Treatment
  • Transudates
    • directed at underlying cause
  • Exudates
    • Drainage if concern for complicated parapneumonic effusions or empyema
    • Indwelling pleural catheter or pleurodesis for recurrent malignant effusions
 

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