Discuss the anatomy and physiologyetiology and pathophysiology of the. Accumulation of fluid between the pleural layers epidemiology of pleural effusion. Pleural disease is, therefore, often a secondary effect of another disease process. It is estimated that a million americans develop a pleural effusion each year 1. Pleural effusion is the most common manifestation of pleural disease and a common presentation of other conditions such as heart failure or kidney failure.
The doctor may then order a chest xray to determine the extent of the effusion. Case presentation malignant pleural effusion edited scribd. We discuss pleural effusion as its definition as the collection of at. A pleural effusion occurs when the pleural fluid that lubricates the surfaces of the pleura the lining around the organs in the chest builds up to abnormal, excessive amounts. Assuming that an effusion excludes nonserous pleural collections, they can be categorized as a transudate or an exudate based on the specific gravity and protein concentration of the fluid. Chest xray is the first test done to confirm the presence of pleural fluid. A pleural effusion is excess fluid that accumulates in the pleural cavity, the fluidfilled space that surrounds the lungs. Wbc 9817 86%pmn14% mono, rbc 1458 pleural fluid chemistry.
Management of malignant pleural effusions american. A 34 yearold woman with a history of heavy alcohol use presents to the emergency room complaining of increasing shortness of breath and rightsided chest pain. In one postmortem series, malignant effusions were found in 15% of patients who died with malignancies. Pleural effusion is commonly used as a catchall term to describe any abnormal accumulation of fluid in the pleural cavity. Pleural effusion is common in various diseases and especially malignant effusions can have rapid onset symptoms such as dyspnea, chest pain, and coughing. Under certain conditions, such as malignant disease of the pleura i. The pleura are thin membranes that line the lungs and the inside of the chest cavity and act to lubricate and facilitate breathing. Definition pleural effusion results from fluid accumulating in the potential space between the visceral and parietal pleura when there is an imbalance between formation and absorption in various disease states, in response to injury, inflammation, or both locally and systematically. Parietal pleurectomy for malignant pleural effusion. Pleural effusion, sometimes referred to as water on the lungs, is the buildup of excess fluid between the layers of the pleura outside the lungs. Pleural effusion national library of medicine pubmed health. Severe pain during thoracentesis pleural fluid cell count. Pathophysiology pleural effusion free download as word doc.
A pleural effusion is an abnormal collection of fluid in the pleural space resulting from excess fluid production or decreased absorption or both. Ppt approach to pleural effusion powerpoint presentation. Definition pleural effusion results from fluid accumulating in the potential space between the visceral and parietal pleura when there is an imbalance between formation and absorption in various disease states, in response to injury, inflammation, or. A pleural effusion is present when there is an excess of fluid in pleural space. Although there have been no epidemiologic studies, the annual incidence of malignant pleural effusions in the united states is estimated to be greater than 150,000 cases table 1. Pleural effusions occur as secondary to a disease process.
A pleural effusion is a buildup of fluid between the layers of tissue that line the lungs and chest cavity. A pseudo chylothorax occurs secondary to a longstanding pleural effusion and is characteristered by the accumulation of cholesterol crystals. Superior vena cava syndrome as a cause of pleural effusion. How is pleural effusion, a pleural cavity disorder, diagnosed. Assuming that an effusion excludes nonserous pleural collections, they can be categorized as a transudate or an exudate based on the specific. In the normal pleural space, there is a steady state in which there is a roughly equal rate of the formation entry and absorption exit of liquid. The pleural fluid may need to be analyzed to determine the underlying cause of the pleural effusion.
Estimated prevalence of pleural effusion is 320 cases per 100,000 people in industrialized countries, with a distribution of etiologies related to the prevalence of. A case study of a patient with a pleural effusion is presented, as well as a brief description of the signs and symptoms, pathophysiology, and management of this disease process. This excess fluid can impair breathing by limiting the expansion of the lungs. Increased hydrostatic pressure gradient decreased oncotic pressure gradient increased capillary or pleural permeability injured blood vessels or thoracic duct lymphatic obstruction ascites.
This balance must be disturbed in order to produce a pleural effusion. Pleural effusions are a common medical problem with more than 50 recognized causes including disease local to the pleura or underlying lung, systemic conditions, organ dysfunction and drugs. If the pleural effusion is small and not causing any problems, then it might be left alone while the cause, such as heart failure or infection, is treated. Pleural effusions can be caused by congestive heart failure, pulmonary embolism, cirrhosis, cancer, infections, openheart surgery and physical trauma. A wellknown risk factor for benign inflammatory exudative pleural effusion is asbestos exposure. Normally, a small amount of fluid is present in the pleura.
Dec 11, 2015 pleural effusion is common in various diseases and especially malignant effusions can have rapid onset symptoms such as dyspnea, chest pain, and coughing. Her past medical history is remarkable for several prior episodes of pancreatitis, likely secondary to her chronic. The diagnosis and the treatment approaches require several pleural techniques and knowledge about concomitant disease. Case 1 77 year old woman with hx of copd 2 week history of uri symptoms zpak and then 10 days antibiotics hospitalized with 3 day history of fever to 39. Estimated prevalence of pleural effusion is 320 cases per 100,000 people in industrialized countries, with a distribution of etiologies related to the prevalence of underlying diseases. There is a logical association between the pleuras physiology and physical attributes and its anatomic and functional construction. In some cases of pleurisy, excess fluid builds up in the pleural space. Pleural effusions are relatively uncommon in patients with acquired immunodeficiency syndrome. An exudative effusion occurs when local factors are altered, such as inflammation of the lung or the pleura leading to capillary leakage of fluid into the pleural space.
Quizlet flashcards, activities and games help you improve your grades. Common risk factors in the development of pleural effusion include preexisting lung damage or disease, chronic smokers, neoplasia e. A pleural effusion is usually diagnosed on the basis of medical history and physical exam, and confirmed by a chest xray. Pleural effusion pulmonary disorders merck manuals. Pleural effusion pe is an excess of fluid in the pleural cavity, resulting from an imbalance between its production, absorption, or both. Pathophysiology of pleural effusion linkedin slideshare.
An effusion is exudative if it meets any of the following three criteria. Physiology and pathophysiology of the pleura springerlink. A diagnosis of pleural effusion may be suggested by characteristic symptoms e. Pleural fluid cytology is the simplest definitive method for obtaining a diagnosis of malignant pleural effusion. Pleural effusion case study free download as word doc. Various kinds of pleural effusion, depending on the nature of the fluid and what caused its entry into the pleural space, are hydrothorax serous fluid, hemothorax blood, urinothorax urine. Pleural effusion is an abnormal, excessive collection of this fluid. So if somebody has a pleural effusion, and this is what were looking at right here, were looking at a set of lungs with a pleural effusion, were going to know that something is wrong based off of a couple of signs and symptoms that well collect from the patient. Pleural effusion secondary to community acquired pneumonia pathophysiology free download as word doc. Pleural effusion national library of medicine pubmed. Repeat thoracentesis of 1 liter of cloudy pleural fluid.
Smoking 9 years family history of tuberculosis invasion of bacteria in the body inflammatory processincrease stimulation stimulate mast of goblet cells cells in the lungs difficulty of breathing increase mucus release of rr36 breathsmin, production chemical mediators shallow and rapid histamine. Jun 30, 2016 a pleural effusion is an abnormal collection of fluid in the pleural space resulting from excess fluid production or decreased absorption or both. In an upright xray, 75 ml of fluid blunts the posterior costophrenic angle. Weight loss 15 lbs in one month pf is a transudate.
The body produces pleural fluid in small amounts to lubricate the surfaces of the pleura. Malignant pleural effusions are a common clinical problem in patients with neoplastic disease. Treatment of malignant pleural effusion with drainage, with and without instillation of talc. It is the most common manifestation of pleural disease, with etiologies ranging from cardiopulmonary disorders to symptomatic inflammatory or malignant diseases requiring urgent evaluation and trea. Management of malignant pleural effusions american journal. Pleural effusion summary radiology reference article. This results in a build up of fluid around the lung that impairs breathing and may lead to restriction of lung function in the long term. The lateral upright chest xray should be examined when a pleural effusion is suspected. So just to kind of revisit what a pleural effusion is. Download as docx, pdf, txt or read online from scribd. Pleural effusion case study respiratory tract respiratory. Pleural effusion classification emergency care institute. Tuberculous pleural effusion results from tuberculous infection of the membrane covering of the lungs. Case studypleural effusion free download as word doc.
The pressure difference between the two pleural sheets is essentially important in regard to the physiology and pathophysiology of the pleural space and its organs. In exudative effusions accompanying inflammatory reactions in pneumonia are the most common reasons. Summarize the definition, epidemiology, pathobiology, clinical manifestations, diagnosis, acute treatment, prognosis, and perhaps most important prevention of drowning. Pleural manometry in pleural effusion sciencedirect. There are many causes of pleural effusion, including pneumonia, tuberculosis, and the spread of a malignant tumour from a distant site to the pleural surface. Sometimes the extra fluid gets infected and turns into an abscess. This is the thin tissue that lines the chest cavity and surrounds the lungs. Smoking 9 years family history of tuberculosis invasion of bacteria in the body inflammatory processincrease stimulation stimulate mast of goblet cells cells in the lungs difficulty of breathing increase mucus release of rr36 breathsmin, production chemical mediators shallow and rapid histamine 01212012. Pleural effusion diagnosis and treatment video khan academy. If symptoms of pleural effusion develop, a tube is inserted through the chest wall into the pleural space to drain the fluid. 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, decreased vocal resonance and. Blunting of the lateral costophrenic angle usually requires about 175 ml but may take as much as 500 ml. Physiology of pleural fluid it is believed that the fluid that normally enters the.
Mechanism of abnormal pleural fluid formation increasedhydrostaticpressurechfincreased hydrostatic pressure chf. A lot of extra fluid can push the pleura against your lung until the lung, or part of it, collapses. Feb 23, 2012 pathophysiology of pleural effusion 1. Case 4 answers pleural effusions clinical respiratory. Pleural effusion diagnosis and treatment video khan. Videoassisted thoracoscopic pleurectomy in the management of malignant pleural effusion. See mechanisms of pleural liquid turnover in the normal state. It is the most common manifestation of pleural disease, with etiologies ranging from cardiopulmonary disorders to symptomatic inflammatory or malignant diseases requiring urgent evaluation and treatment. Given that most effusions are detected by xray, which generally cannot distinguish between fluid types, the fluid in question maybe. Carlo oller, emergency physician, talks about pleural effusion. Pleural manometry provides data to enhance our understanding of the underlying pleural pathophysiology when an effusion is present and aids the physician in both diagnostic and therapeutic decisions, and can help him to avoid unsafe pressure changes during thoracentesis and to. The diagnostic yield is dependent on such factors as extent of disease and the nature of the primary malignancy. Treating the cause will often make the pleural effusion disappear. A doctor can make a preliminary diagnosis of pleural effusion by using a stethoscope to listen to the breathing sounds, as well as the sounds from tapping on the chest.
It can pose a diagnostic dilemma to the treating physician because it may be related to disorders of the lung or pleura, or to. Approach to pleural effusion 1 approach to pleural effusion. The lack of specificity is mainly due to the limitations of the imaging modality. The treatment depends on the cause of the pleural effusion and its severity.
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