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Pleural Disease
 
 

Pleural Effusion

 
 
 
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Pathogenesis

  • Causes of Pleural Effusion

  • Exudative

  • Malignancy
  • Infection - parapneumonic effusion, empyema, viral, fungal, TB, ruptured abscess / cyst
  • Pulmonary embolism (90% exudative)
  • Autoimmune disease - rheumatoid pleuritis, SLE
  • Pancreatitis
  • Haemothorax
  • Chylothorax
  • Asbestosis
  • Uraemia
  • Oesophageal rupture
  • Transudative

  • Heart failure
  • Cirrhosis
  • Hypoalbuminaemia
  • Nephrotic syndrome
  • Pulmonary embolism (10% transudative)
  • Myxoedema
  • Meig’s syndrome
  • Constrictive pericarditis
  • SVC obstruction
  • Urinothorax

Diagnosis

  • Clinical Signs

  • Oxygen requirement - reduced SpO2, oxygen delivery
  • Dull percussion note
  • Reduced tactile fremitus
  • Reduced breath sounds
  • Reduced vocal resonance
  • Chest X-Ray Signs of Pleural Effusion

  • Loss of the costophrenic angle
  • Increased density of the affected hemithorax
  • Pseudo-elevation of the diaphragm
  • Loss of lower lobe vessels
  • Small bilateral pleural effusions evidenced by bibasal costophrenic blunting
  • Small bilateral pleural effusions evidenced by bibasal costophrenic blunting
     
  • Left-sided pleural effusion
  • No Overlay
    Overlay
    Left-sided pleural effusion
     
  • Large right-sided pleural effusion
  • Large right-sided pleural effusion
     
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