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What are the sign, symptoms, and treatment of pleural effusion?

1 Answer
Minal

Pleural Effusion (PE) is the collection of excess fluid in the pleural space due to either excess pleural fluid formation or decreased fluid removal by the pleural lymphatic. It is of two types.

  • Transudative PE: congestive heart failure, cirrhosis, nephrotic syndrome, pulmonary embolism, myxoedema, superior vena cava obstruction.
  • Exudative PE: infectious diseases, neoplastic diseases, pulmonary embolization/infarction, collagen vascular diseases, gastrointestinal diseases, drugs and toxins, traumatic, chronic uremia, chronic diseases.

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Sign and Symptoms:

  • Pleuritic chest pain more on inspiration, coughing, laughing, sneezing
  • Dyspnoea
  • A dry cough
  • Hypoxemia
  • Fever
  • Anorexia
  • Malaise
  • Weight loss
  • Decreased mobility of chest wall on affected side
  • Shift of mediastinum to opposite side
  • Decreased breath sound
  • Dullness to percussion
  • Decreased to tactile fremitus
  • Pleural rub
  • Skodatic resonance
  • Egophony

Diagnosis:

  • CBC, ESR
  • Sputum examination: Gram & Ziehl-Neelsen’s stain & culture
  • X-ray Chest: obliteration of costo-phrenic angle on affected side (150 ml fluid)
  • CT Scan
  • Ultrasound (USG)
  • Thoracocentesis
  • Pleural biopsy
  • Thoracoscopy

Pleural Fluid Analysis:

  • Purulent/Serous
  • Haemorrhagic
  • Milky
  • Greenish: Pseudomonas, Streptococcus, Pneumococcus
  • Gold Paint: Myxedema
  • Anchovy Sauce: ruptured amoebic liver abscess

Microscopic:

  • Lymphocytic predominance
  • Polymorphic predominance
  • Eosinophilic predominance
  • WBC count > 10000/cumm
  • Biochemical investigation
  • Proteins > 3 gm % - exudate, < 3 gm % - transudate
  • Sugar
  • LDH
  • Amylase
  • Adenosine Deaminase Hyaluronidase
  • Albumin
  • Cell count
  • Gram Stain
  • Cytology
  • pH
  • TB markers

Treatment:

  • Transudative PE: Thoracocentesis or pleural Tapping.
  • Malignant PE: repeated thoracocentesis, Pleurodesis or indwelling catheter for frequent recurrence.
  • Haemothorax: Intercostal  drainage(ICD)
  • Chest Physiotherapy.
  • Antibiotics.
  • Intra-pleural thrombolytic agent.
  • Thoracostomy.
  • Open drainage and rib resection.
  • Thoracic surgery
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