SHM's Clinical Quick Talks-Pleural Effusions

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Pleural effusion is an abnormal accumulation of fluid in the pleural space. There are two types of pleural effusion: transudative and exudative. Transudative effusions are a result of pressure filtration without capillary injury, while exudative effusions are a result of inflammatory fluid leaking between cells. The most common causes of transudative effusion are LV failure and cirrhosis, while the most common causes of exudative effusion are bacterial pneumonia, viral infection, and malignancy.<br /><br />The clinical manifestations of pleural effusion can vary depending on the underlying disease, and small effusions can be asymptomatic. Common symptoms include dyspnea, cough, and chest pain. Physical examination may reveal diminished breath sounds, dullness to percussion, and decreased tactile fremitus.<br /><br />The diagnosis of pleural effusion involves several tests, including thoracentesis, which is the gold standard test for differentiating between transudative and exudative effusions. Other tests include analyzing the pleural fluid white blood cell count, protein, LDH, glucose, and pH levels. Pleural fluid cytology is the gold standard for evaluating malignancy, while gram stain and culture are used for bacterial effusion.<br /><br />Treatment for pleural effusion depends on the underlying cause. Transudative effusions are treated by addressing the underlying systemic disorder, while exudative effusions may require further testing to determine the local disorder. Chest tube placement is indicated for complicated parapneumonic effusion or if there is pus in the pleural space.<br /><br />It is important to perform a pleural biopsy if tuberculosis is suspected, as cultures have a low sensitivity. Effusion cytology is the diagnostic test of choice for malignancy. Pulmonary embolism should be considered in the workup of a pleural effusion, and post-procedure chest X-ray should be obtained after thoracentesis to rule out pneumothorax. Re-expansion pulmonary edema can occur if a large volume of fluid is removed in one session.<br /><br />In conclusion, pleural effusion is a common condition that requires careful evaluation to determine the underlying cause. Treatment should be tailored to address the specific etiology of the effusion.

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Salim Rezaie

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pleural effusion

transudative effusion

exudative effusion

LV failure

cirrhosis

bacterial pneumonia

viral infection

malignancy

thoracentesis

chest tube placement