Pathology: Increasein fluid formation and/or absorption in the pleural space. The pathology is dependent on aetiology anddivided into transudates and exudates.
Aetiology: Exudate (protein >35g/L) due to increased microvascular permeability
- Malignancye.g. metastatic carcinoma, mesothelioma
- Infectione.g. TB, parapneumonic, empyema
- Inflammatione.g. SLE, RA, post-CABG, benign asbestos effusion and drugs
Transudate (protein <35g/L) due to hydrostaticpressure or osmotic pressure:
- Cardiace.g. LVF, mitral stenosis, constrictive pericarditis
- Renale.g. peritoneal dialysis, Nephrotic syndrome
- Livere.g. cirrhosis, ascites, hypoalbuminaemia
Symptoms: Shortnessof breath, occasional pleuritic pain
Signs: Tracheadisplaced away from effusion, reduced chest movement on affected side, stonydull percussion, reduced vocal fremitus, reduced breath sounds
Investigations: Imaging: Chest X-Ray ultrasound, CTchest
Pleural Fluid: Diagnostic aspiration
Pleural Biopsy: e.g. Abram’s needle, radiologically guided, VATs
Fluid Samples: LDH and protein, M,C&S, AFB andTB culture
Treatment: Treatunderlying cause
Therapeutic aspiration of 1-1.5L can be performed forsymptomatic effusions
In some cases a chest drain may be needed.
Complications: Breathlessness,empyema
Prognosis: Dependentof cause
Figure 2.3 Large rightand small left pleural effusions
