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Case Study (Pleural Effusion)

Pleural effusions occur when excess fluid accumulates in the pleural cavity between the lungs and chest wall. This can impair breathing by limiting lung expansion. Symptoms include chest pain, difficulty breathing, and coughing. Pleural effusions are classified as transudative or exudative based on their protein and LDH levels. Transudative effusions are usually caused by conditions that raise pressure in blood or other vessels, while exudative effusions result from inflammation or infection of the lungs or pleura. Diagnosis involves imaging tests and fluid analysis to determine the cause and appropriate treatment.

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1K views

Case Study (Pleural Effusion)

Pleural effusions occur when excess fluid accumulates in the pleural cavity between the lungs and chest wall. This can impair breathing by limiting lung expansion. Symptoms include chest pain, difficulty breathing, and coughing. Pleural effusions are classified as transudative or exudative based on their protein and LDH levels. Transudative effusions are usually caused by conditions that raise pressure in blood or other vessels, while exudative effusions result from inflammation or infection of the lungs or pleura. Diagnosis involves imaging tests and fluid analysis to determine the cause and appropriate treatment.

Uploaded by

Jvspapa Shiloh
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Web definitions

 Pleural effusion is excess fluid that accumulates in the pleural cavity, the fluid-filled
space that surrounds the lungs. Excessive amounts of such fluid can impair breathing
by limiting the expansion of the lungs during inhalation.

en.wikipedia.org/wiki/Pleural_effusion

Signs & Symptoms of Pleural Effusions

Pressure on the chest, chest pain, dyspnea (difficulty breathing) and excessive cough are some
of the common symptoms of pleural effusions. Excessive pleural fluids can cause intense
inflammation of the pleural surfaces and acute pain for the patient. If the pleural effusions is
between the 500-1500 ml range, this causes chest pressure. If the effusions is greater than
1500 ml, this can cause dyspnea which is a difficulty in breathing. Dyspnea rarely occurs
when the fluid in the pleura is low, thus a difficulty in breathing signals doctors that there are
excess fluids in the lungs. Dyspnea occurs not only when the patient is active such as running
or jogging, but it can also occur when the patient is relaxing or sleeping.

Definition
A pleural effusion is an accumulation of fluid between the layers of the membrane that lines
the lungs and chest cavity.

Alternative Names

Fluid in the chest; Pleural fluid

Causes

Your body produces pleural fluid in small amounts to lubricate the surfaces of the pleura, the
thin membrane that lines the chest cavity and surrounds the lungs. A pleural effusion is an
abnormal collection of this fluid.

Two different types of effusions can develop:

 Transudative pleural effusions are often caused by abnormal lung pressure. Congestive
heart failure is the most common cause.
 Exudative effusions form as a result of inflammation (irritation and swelling) of the
pleura. This is often caused by lung disease. Examples include lung cancer,
pneumonia, tuberculosis and other lung infections, drug reactions, asbestosis, and
sarcoidosis.

Symptoms

 Shortness of breath
 Chest pain, usually a sharp pain that is worse with cough or deep breaths
 Cough
 Hiccups
 Rapid breathing

There may be no symptoms.

Exams and Tests

During a physical examination, the doctor will listen to the sound of your breathing with a
stethoscope and may tap on your chest to listen for dullness.

The following tests may help to confirm a diagnosis:

 Chest x-ray
 Thoracic CT
 Ultrasound of the chest
 Thoracentesis
 Pleural fluid analysis

The cause and type of pleural effusion is usually determined by thoracentesis (a sample of
fluid is removed with a needle inserted between the ribs).

Treatment
Treatment may be directed at removing the fluid, preventing its re-accumulation, or
addressing the underlying cause of the fluid buildup.

Therapeutic thoracentesis may be done if the fluid collection is large and causing pressure,
shortness of breath, or other breathing problems, such as low oxygen levels. Treatment of the
underlying cause of the effusion then becomes the goal.

For example, pleural effusions caused by congestive heart failure are treated with diuretics
and other medications that treat heart failure. Pleural effusions caused by infection are treated
with antibiotics specific to the causative organism. In patients with cancer or infections, the
effusion is often treated by using a chest tube to drain the fluid. Chemotherapy, radiation
therapy, or instilling medication within the chest that prevents re-accumulation of fluid after
drainage may be used in some cases.

Outlook (Prognosis)

The expected outcome depends upon the underlying disease.

Possible Complications

 A lung surrounded by a fluid collection for a long time may collapse.


 Pleural fluid that becomes infected may turn into an abscess, called an empyema,
which requires prolonged drainage with a chest tube placed into the fluid collection.
 Pneumothorax (air within the chest cavity) can be a complication of the thoracentesis
procedure.
 In rare cases, surgery is needed to remove the abscess.

When to Contact a Medical Professional

Call your health care provider if symptoms suggestive of pleural effusion develop.

Call your provider or go to the emergency room if shortness of breath or difficulty breathing
occurs immediately after thoracentesis.

Two classifications are 1) transudate pleural effusions; and 2) exudate pleural effusions.
Sometimes the pleural effusion can have characteristics of both a transudate and an exudate.

1. Transudate pleural effusions are formed when fluid leaks from blood vessels into the
pleural space. Chemically, transudate pleural effusions contain less protein and LDH (lactate
dehydrogenase) than exudate pleural effusions. If both the pleural fluid–to–serum total protein
ratio is less than or equal to 0.50 and the pleural fluid–to–serum LDH ratios are less than or
equal to 0.67, the fluid is usually considered to be a transudate while exudates ratios are above
0.50 and above 0.67.

Examples of transudate pleural effusions include:

 congestive heart failure,

 liver failure or cirrhosis,


 kidney failure or nephritic syndrome, and

 peritoneal dialysis.

2. Exudate pleural effusions are caused by inflammation of the pleura itself and are often
due to disease of the lung.

Examples of exudate causes include:

 lung or breast cancer,

 lymphoma,

 pneumonia,

 tuberculosis,

 post pericardotomy syndrome,

 systemic lupus erythematosus,

 uremia or kidney failure,

 Meigs syndrome,

 pancreatic pseudocyst,

 ascites,

 intra abdominal abscess, and

 asbestosis and mesothelioma.

Most pleural effusions are caused by congestive heart failure, pneumonia, pulmonary
embolism and malignancy.

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