Pleural Effusion PDF

Pleural Effusion Dr. Ahmed Hamad MBBS, PgDip (Therapeutics), MRCP (Respiratory Medicine), FRCP (London), FACP Consultant Pulmonologist PMAH, Riyadh  Objectives Pathophysiology Main causes Differentiate among...

Pleural Effusion Dr. Ahmed Hamad MBBS, PgDip (Therapeutics), MRCP (Respiratory Medicine), FRCP (London), FACP Consultant Pulmonologist PMAH, Riyadh  Objectives Pathophysiology Main causes Differentiate among manifestations Clinical features Diagnostic methods Treatment options  881stlaid Pathophysiology 20 0 Pleural space normally contains 10-20 mls of serous fluid o_0__ Secreted from capillaries of parietal pleura Reabsorbed by capillaries of visceral pleura and lymphatics a Pleural effusion occurs when imbalance between secretion and reabsorption results in fluid accumulation in pleural space. e 0 Depending on protein content of pleural fluid, can be divided in: Transudate (low-protein) Exudate (high-protein)  Pathophysiology Transudative effusion – Increase hydrostatic pressure t.EE iiamur bonesticPressure – Decrease oncotic pressure m.EE Albumin i iars Em rstein Exudative effusion capillarypermeability – Increased capillary permeability __ Transudative effusion Causes Exudative effusion causes PavaPneumonic Clinical presentation Examination signs symptoms History Dyspnoia Decreased or absent tactile Cough fremitus Chest pain Dullness to percussion Symptoms of underlying cause Absent or decreased breath sounds Signs of underlying cause 00 s  J e Investigations CXR US thorax CT chest Pleural fluid sampling die Eerie Cytology, microbiology, biochemistry Thoracoscopy +/- Pleural biopsy Treatment Treatment of underlying cause Small effusions Observation Large or symptomatic pleural effusions G Therapeutic Thoracentesis (removal of 1-1.5 L) 0 7 Chest tube insertion Recurrent effusion Chest tube insertion+\- pleurodesis Indwelling pleural catheter Surgery  34 y male came to ER c/o SOB, cough for 2months, weight loss, haemoptysis to e oooo CXR: LT sid pleural effusion Serum: TP: 21. LDH: 250 pleural fluid result: TP: 22g/dl LDH : 1200 Glucose: 30 PH:7.2 AFB: -VE Cell count & diff: Lymphocyte 90% PMN 10% Transudate or Exudate ?? Differential Diagnosis Treatment