![]() CT or ultrasound chest: to further characterise pleural effusion and investigate for an underlying cause.Other relevant imaging investigations include: Look for consolidation (infection), malignancy, cardiomegaly (cardiac failure) and pleural plaques (asbestos exposure). 1Ī chest X-ray is also useful to assess for the underlying aetiology of the pleural effusion. A unilateral effusion is typically exudative whereas bilateral effusions are typically transudative.ĥ0ml of pleural fluid can cause costophrenic blunting, but >200ml fluid is needed to be visible on PA film. This is useful to assess a pleural effusion and estimate its size. LFTs, U&Es, albumin, coagulation profile: to look for liver and renal diseaseĪ chest X-ray is the first-line imaging investigation of choice.D-dimer: if a pulmonary embolism is suspected.Arterial blood gas: if oxygenation if affected.FBC/CRP/blood cultures: to look for infection.Relevant laboratory investigations include: Urine dip: to assess for proteinuria which may indicate nephrotic syndrome.ECG: to look for a cardiac cause of chest pain and breathlessness or signs of right heart strain which may indicate a pulmonary embolism.Infection: such as pneumonia or tuberculosisĬhest X-ray is a useful initial investigation when suspecting a pleural effusion, however, it is important to also consider other investigations to ascertain the aetiology of the effusion.When auscultating, breath sounds and vocal resonance are reduced or absent over an effusion.īreathlessness, cough and pleuritic chest pain are typical presenting features of a pleural effusion but important differentials to consider include: On percussion, a pleural effusion classically sounds ‘stony’ dull. There may also be reduced tactile vocal fremitus over the pleural effusion. Palpation may reveal tracheal deviation away from the affected side and reduced chest expansion on the affected side. On closer inspection of the chest, a larger pleural effusion may cause reduced chest movement on the affected side. On peripheral inspection lookout for nicotine staining of fingers, clubbing (lung cancer), evidence of joint deformity (rheumatoid arthritis) and signs of fluid overload (heart failure). In the context of a pleural effusion, a thorough respiratory examination is required. Social history: smoking history (lung cancer risk), asbestos exposure (mesothelioma).Symptoms suggestive of infection: productive cough, fever.Symptoms suggestive of heart failure: orthopnoea, paroxysmal nocturnal dyspnoea, leg swelling.Symptoms suggestive of lung cancer: haemoptysis, weight loss.Other important areas to cover in the history include: Typical symptoms of a pleural effusion include: 1 ![]() As the pleural effusion increases in size, symptoms begin to develop. Small and moderate pleural effusions are commonly asymptomatic. Rare: yellow nail syndrome, drugs (methotrexate, amiodarone, nitrofurantoin, phenytoin)Ĭhylothorax: chyle in the pleural space due to disruption of the thoracic duct (due to a neoplasm, trauma or infection/inflammation) rheumatoid arthritis), pancreatitis, post-myocardial infarction (Dressler’s syndrome), post coronary artery bypass grafting, asbestos Less common: pulmonary infarction, autoimmune diseases (e.g. Rare: Meigs’ syndrome (benign ovarian tumour, ascites, pleural effusion)Ĭommon: infection (parapneumonic, tuberculosis), malignancy Less common: hypoalbuminemia, nephrotic syndrome, peritoneal dialysis, hypothyroidism 1 TypeĬommon: ‘the failures’: heart failure, cirrhosis (liver failure) An overview of the causes of pleural effusions. Fluid accumulates due to increased pleural and capillary permeability. Transudates have a low protein level of 35g/L. Pleural effusions are usually classified as transudative or exudative. Anatomy of the chest wall and pleural membranes. Pleural effusions occur when fluid accumulates in the pleural space. The serous fluid allows the visceral and parietal pleura to slide over each other during respiration and creates surface tension between the two layers. The potential space between the visceral and parietal pleura contains a small amount of lubricating serous fluid. This is a serous membrane divided into the visceral pleura (lines the lungs) and parietal pleura (lines the internal thoracic cavity). The lungs are surrounded by the pleural membrane. You might also be interested in our medical flashcard collection which contains over 1000 flashcards that cover key medical topics.
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