Pleural effusion

Definition:

• An excessive collection of fluid in the pleural space
• Can be detected by X-ray when >300ml of fluid is present
• Can be detected clinically when >500ml of fluid is present

Clinical signs:

• Decreased chest expansion on affected side
• Mediastinum displaced away from lesion (in massive effusions)
• Stony dull to percussion
• Vesicular breath sounds – reduced or absent
• Reduced or absent vocal resonance
• No added sounds

Diagnosis:

• Pleural aspiration
• The fluid that accumulates may be a transudate or an exudate

Transudates:

Causes include:

• Heart failure
• Hypoproteinaemia (e.g. nephrotic syndrome)
• Constrictive pericarditis
• Hypothyroidism
• Ovarian tumours

Exudates:

Causes include:

• Bacterial pneumonia (common)
• Bronchial carcinoma
• TB
• Connective tissue disease

Treatment is of the underlying pathology