this lecture focus on plural effusion definition,anatomy of plural space ,causes,diagnosis, physical examination and symptoms,treatmeny

1. Pleural effusion
Prepared by
Ali Awas Third Year Medical Student

2. The pleural effusion: is excess fluid that
accumulates in the pleural cavity.

3. Physiology and antomy
of the Normal Lungs
the pleural cavity is the thin fluid-filled space between the two pulmonary pleurae
of each lung.
A pleura is a serous membrane which folds back onto itself to form a two-layered
membranous pleural sac.
The pleura consists of 2 layers
1 – parietal pleura:The outer pleura
2 – visceral pleura:The inner pleura
serous fluid that allows for the parietal pleura (outer lining) and visceral pleura
(inner lining) to glide over each other without separation
The space between the 2 layers is called the pleural space
Normal width of the pleural space is
10-20 mm
-Pleural fluid is produced by the parietal pleura and absorbed by the visceral pleura
as a continuous process.

7. Various methods can be used to classify pleural fluid.
 By the origin of the fluid:
 Serous fluid (hydrothorax)
 Blood (haemothorax)
 Chyle (chylothorax)
 Pus (pyothorax or empyema)
 Urine (urinothorax)
 By pathophysiology:
 Transudative pleural effusion
 Exudative pleural effusion

8. Pathophysiology
.
Exudative pleural effuisions occur when the pleura
is damaged, e.g., by trauma, infection or
malignancy, and
transudative pleural effusions develop when there
is either excessive production of pleural fluid or
the resorption capacity is exceeded.

9. Types of Effusions
:TRANSUDATIVE PLEURAL EFFUSIONS
a fluid substance that has passed through a membrane or
has been extruded from a tissue it is of high fluidity
and has a low content of protein, cells, or solid
materials derived from cells. It caused by fluid leaking
into the pleural space. This is caused by increased
pressure in, or low protein content in, the blood vessels
. A transudate is a clear fluid, similar to blood serum .
It reflect a systemic disturbance of body

10. Causes of Transudates
Congestive heart failure
Liver cirrhosis
Severe hypoalbuminemia
Nephrotic syndrome
Parapneumonic effusion due to pneumonia
Acute atelectasis

11. Types Of Effusions
cont..
:EXUDATIVE EFFUSIONS
A fluid rich in protein and cellular elements that oozes out
of blood vessels due to inflammation . An exudate—
which often is a cloudy fluid, containing cells and much
protein . signify underlying local (pleuropulmonary)
disease.

12. Causes of Exudates:
 After heart surgery (from incomplete evacuation of
blood resulting in retained blood syndrome)
 Malignancy (either lung cancer or metastases to the
pleura from elsewhere)
 Infection (emypema due to bacterial pneumonia)
 Trauma
 Pulmonary infarction
 Pulmonary embolism

16. Types of fluids
Four types of fluids can accumulate in the pleural space:
1-Serous fluid (hydrothorax) :
A hydrothorax is a condition that results from serous fluid
accumulating in the pleural cavity. This specific condition
can be related to cirrhosis with ascites in which ascitic
fluid leaks into the pleural cavity
2-Blood (haemothorax):
is a condition that results from blood accumulating in the
pleural cavity

17. 3-Chyle (chylothorax):
chyle is a milky bodily fluid consisting of lymph and
emulsified fats, or free fatty acids (FFAs). It is formed in
the small intestine during digestion of fatty foods .It is a
type of pleural effusion . It results from lymphatic fluid
(chyle) accumulating in the pleural cavity.
4-Pus (pyothorax or empyema) :
is an accumulation of pus in the pleural cavity

18. CLINICAL MANIFESTATION
A pleural effusion is usually diagnosed on the basis
of medical history and physical exam, and
confirmed by a chest X-ray.
Once accumulated fluid is more than 300 mL, there
are usually detectable clinical signs, such as
decreased movement of the chest on the affected
side, dullness to percussion over the fluid,
diminished breath sounds on the affected side

19. imaging
Chest Radiography
A pleural effusion appears as an area of whiteness on a standard
posteroanterior chest X-ray.
Lung Ultrasound:
Lung ultrasound, nearly as accurate as CT and more accurate
than chest X-ray, is increasingly being used at the point of care
to diagnose pleural effusions, with the advantage that it is a safe,
dynamic, and repeatable imaging modality.
Computed Tomography:
is more accurate for diagnosis and may be obtained to better
characterize the presence, size, and characteristics of a pleural
effusion.

20. Pleural effusion
A large left sided pleural effusion as seen
on an upright chest X-ray
Pleural effusion Chest X-ray of a pleural
effusion. The arrow A shows fluid layering in
the right pleural cavity. The B arrow shows
the normal width of the lung in the cavity

23. Diagnosis
.
Thoracentesis:
Once a pleural effusion is diagnosed, its cause must be determined.
Pleural fluid is drawn out of the pleural space in a process called
thoracentesis, and it should be done in almost all patients who
have pleural fluid that is at least 10 mm in thickness on CT,
ultrasonography, or lateral decubitus X-ray and that is new or of
uncertain etiology. In general, the only patients who do not require
thoracentesis are those who have heart failure with symmetric
pleural effusions and no chest pain or fever; in these patients,
diuresis can be tried, and thoracentesis avoided unless effusions
persist for more than 3 days.[

24. Treatment:
 Treatment depends on the underlying cause of the pleural
effusion.
 Therapeutic aspiration may be sufficient; larger effusions
may require insertion of an intercostal drain