Pleural Effusion

Pleural Effusion is a collection of fluid in the pleural cavity or cavity between the parietal pleura and visceral pleura, can be fluid transudates or exudates.

Pathophysiology and Etiology
- Transudates:
An extracellular fluid that collects in the pleural lavum passively. With a specific gravity of the liquid is less than 1.015; protein in the fluid of less than 2-3 g / dl. Can occur as part of a general or edema in left heart failure.
Generally the cause is: an increase in pulmonary venous pressure, hypoalbuminaemia and mediastinitis fibrosis or miksedema.


- Exudate:
Fluid in the pleural cavity caused by infectious diseases or neoplasms, generally protein levels> 3 g / dl, yellow or orange, with or without cells or bacteria.
Generally it can be caused by inflammation, neoplasm, and abnormal lymph drainage.

Clinical Symptoms

• Shortness of breath is the main symptom, sometimes accompanied by feelings of discomfort in the chest. When pleural fluid is low, can not be detected by clinical examination, but can be detected by radiography.
• Sometimes accompanied by pleural pain or non-productive cough. But pleural effusion is more often a complication of bacterial pneumonia.

Physical examination.

• There is usually a symptom of the disease essentially.
• If shortness of breath that stand out, most likely because the process of malignancy.
• Effusions shaped bag (pocketed) the fissure interlobaris not give symptoms. Similarly, if efusinya is above the diaphragm.
• Unilateral pleural effusion is often due to infection in the lung tissue before.
• Bilateral pleural effusions, possibly due to heart failure, hipoproteinemia, pulmonary embolism.
• On percussion, the voice sounded faint revealed in accordance with the extent of effusion.
• On auscultation breath sounds decreased or disappeared.
• Diminished vocal resonance.

Chest X-Ray photo.

• PA chest X-ray photos, to see the surface of the pleural fluid.
• The amount of pleural fluid> 300 cc visible on chest X picture in the decubitus position.
• Pleural effusions seen on chest X-shaped photo bag (pocketed), still need to be distinguished with the same picture of other diseases, because it must be careful in making conclusions.
• At least costofrenicus sinus effusions seem dull.
• Effusions in large quantities causing mediastinal shift towards the healthy. But if there is no shift of the mediastinum, the possibility of lung collapse with effusion.

Laboratory.
Macroscopic

• Fluid aspiration and biopsy can be used to diagnose diseases and as a culture.
• Sometimes torakoskopi examination to aid diagnosis.
• Viewed with the naked eye, the normal pleural effusion clear yellow. If the pleural effusion showed a lot of turbid PMN cells, or containing cholesterol or fatty items. When white as milk, indicating the existence of chylous fluid.

Microscopic

• Pleural fluid can be used for cytology and arithmetic types.
• Effusions containing large amounts of red blood cells, possibly due to malignancy or pulmonary infarction. When the lot containing PMN cells indicating bacterial infection.

Lymphocytes in the pleural fluid is not typical for tuberculosis fluid. Eosinophils in large amounts, the possibility of disease in connective tissue or "eosinophilic pleural effusion".

Biochemistry

• Protein> 3 g / dl --> exudate. Protein <3 g / dl --> transudates
• Glucose < normal --> "rheumatoid pleural effusion". Another possibility for malignancy or purulent. 
• Cholesterol --> indicates the process or perhaps because of chronic rheumatoid. 
• Amylase -->  pancreatitis or pancreatic carcinoma. 

Serologic Tests
Rheumatoid and systemic lupus erythematosus are often given anti-nuclear factor and rheumatoid factor positive.

Differential Diagnosis

• Consolidation of the lung due to pneumonia
• neoplasms with lung collapse
• Pneumothorax
• Pleural Fibrosis.

Other Pleural effusion
"Chylothorax" pleural effusion is caused due to leakage from the duct torasicus. These leaks can be caused by trauma or blockage filiariasis in the tropics.

Management Of Pleural effusion

Complications
Empyema

Prognosis

• Usually cured after being given adequate treatment of basic diseases. 
• Empyema may arise due to lung infections like pneumonia.

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