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Pleural Effusion.

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Presentation on theme: "Pleural Effusion."— Presentation transcript:

1 Pleural Effusion


3 Pleural Effusion-Definition
it is an abnormal collection of fluid in the pleural space resulting from excess fluid production or decreased absorption. It is the most common manifestation of pleural disease, with etiologies ranging from cardiopulmonary disorders to symptomatic inflammatory or malignant diseases.

4 Pleural Effusion The prevalence of pleural effusion is slightly in excess of 400/ population. Approximately 1.5 million pleural effusions are diagnosed in the United States each year.


6 Pleural Effusion-Causes
Transudative Exudative Unilateral Bilateral

7 Transudative Causes Conditions associated with transudative pleural effusions: Congestive Heart Failure (CHF) Hepatic cirrhosis Hypoproteinemia Nephrotic syndrome Acute atelectasis Myxedema Peritoneal dialysis Meig's syndrome Obstructive uropathy

8 Exudative causes Conditions associated with exudative pleural effusions: Malignancy Infection Trauma Pulmonary infarction Pulmonary embolism Autoimmune disorders Pancreatitis Rheumatoid Pleurisy Drug-induced Lupus Tuberculosis

9 Pleural Effusion-Pathophysiology


11 Pleural Effusion-Diagnosis
History Physical Examination X-ray Chest Ultrasonography CT Scan Thoracocentesis (Diagnostic) Pleural Biopsy

12 Pleural Effusion-History
Dyspnea Cough Chest pain Weakness Fever Weight loss Hemoptysis History of trauma, cardiac surgery, cancers

13 Pleural Effusion-Physical Examination
Clinically detectable when more than 500 ml Inspection Palpation Chest expansion and excursion Tactile fremitus Percussion Auscultation Breath sounds Vocal fremitus

14 Pleural Effusion- Xray Chest






20 Peural effusion Ultrasonography & Tomography

21 Pleural Effusion Diagnostic Thoracocentesis

22 Pleural Effusion Diagnostic Thoracocentesis
Colour and gross appearance



25 Pleural Effusion Diagnostic Thoracocentesis
Colour Biochemical Analysis Protein Glucose LDH Microbiology Gram Staining ZN Staining


27 Pleural Effusion Diagnostic Thoracocentesis
Cytology TLC DLC Malignant cytology Culture & Sensitivity Bacterial Mycobacterial Fungal

28 Pleural Biopsy

29 Pleural Effusion-Treatment
Treat the cause Diuretics Antibiotics Albumin Corticosteroids Anti-inflammatory agents Immunosuppressants

30 Treat the cause Malignancy Infection Trauma
Pulmonary infarction & Embolism Pancreatitis Rheumatoid Pleurisy Tuberculosis

31 Treat the cause Congestive Heart Failure (CHF) Cirrhosis
Hypoproteinemia Nephrotic syndrome Myxedema

32 Thoracocentesis From Greek, thorax + centesis, puncture) also known as pleural tap, It is an invasive procedure to remove fluid or air from the pleural space for diagnostic or therapeutic purposes. A cannula, or hollow needle, is carefully introduced into the thorax, generally after administration of local anesthesia. The procedure was first described in 1852. The recommended location varies. midaxillary line, in the eighth, ninth, or tenth intercostal space. Whenever possible, the procedure should be performed under ultrasound guidance, which has shown to reduce complications.

33 Therapeutic Thoracocentesis

34 Therapeutic Thoracocentesis

35 Precautions-thoracocentesis
Pain free Proper position and posture Selection of exact location to be punctured Bleeding profile Amount of fluid to be taken out Post procedure precautions

36 Thoracocentesis Contraindications An uncooperative patient
Coagulation disorder Relative contraindications include cases in which the site of insertion has known emphysema Patient is on  mechanical ventilation Only one functioning lung 

37 Thoracocentesis Complications Pneumothorax Hemothorax Hemopneumothorax
Hypotension Pulmonary edema Minor complications include: A dry tap (no fluid return) Subcutaneous hematoma or seroma Anxiety,  Dyspnea and cough The use of ultrasound for needle guidance can minimize the complication rate.


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