Pleural Effusion (Pulmonary Medicine)

Acute

What is Pleural Effusion?

Pleural effusion is the abnormal fluid accumulation within the pleural space, the thin cavity between the pleural layers surrounding the lungs. Under normal circumstances, a small amount of fluid is continuously produced and reabsorbed within this space to maintain lubrication and facilitate smooth movement of the lungs during respiration. However, various pathological processes can disrupt this equilibrium, leading to excessive fluid accumulation.

  • shortness of breath.
  • fatigue (extreme tiredness)
  • a high temperature and sweating
  • a persistent cough.
  • loss of appetite and unexplained weight loss.
  • Chest Pain
  • Empyema
  • systemic infection,
  • sepsis,
  • respiratory compromise
  • fibrous adhesions
  • Pleural thickening

Transudative pleural effusion include conditions that alter the hydrostatic or oncotic pressures in the pleural space, such as congestive left heart failure (CHF), nephrotic syndrome, liver cirrhosis, hypoalbuminemia, or peritoneal dialysis.

Exudative pleural effusion etiologies include pulmonary infections such as pneumonia or tuberculosis, malignancy, inflammatory disorders like pancreatitis, lupus, rheumatoid arthritis, postcardiac injury syndrome, chylothorax, hemothorax, postcoronary artery bypass grafting (post-CABG), and benign asbestos pleural effusion.

Some of the less common causes of pleural effusion are pulmonary embolism (exudative or transudative), drug-induced reactions (exudative), radiotherapy (exudative), esophageal rupture (exudative), and ovarian hyperstimulation syndrome (exudative). Drugs frequently implicated in the development of pleural effusion include methotrexate, amiodarone, phenytoin, and dasatinib.

Primary preventive measures for pleural effusion involve preventing the development of conditions that can lead to its occurrence. These preventive actions include engaging in regular physical activity, maintaining a healthy diet, limiting alcohol consumption, and abstaining from smoking.

Vaccinating against infectious diseases like pneumonia and influenza can also help prevent respiratory infections that may contribute to pleural effusion.

Occupational safety measures, such as proper respiratory protection in workplaces with potential exposure to hazardous materials, can also reduce the risk of developing pleural effusion due to occupational lung diseases.

Regular health check-ups, particularly for individuals with underlying risk factors such as heart or lung conditions, can facilitate early identification of symptoms suggestive of pleural effusion.

Timely treatment of underlying medical conditions, such as heart failure or pneumonia, can help prevent the progression of these conditions to pleural effusion.

How is it diagnosed?

How is it diagnosed?

Management primarily revolves around identifying and treating the underlying cause. Pleural fluid drainage is recommended for treating symptomatic patients. In asymptomatic patients, drainage is performed only as part of the diagnostic process unless signs and symptoms of hemorrhage or infection are present. A thoracentesis in the setting of heart failure is recommended only if diuretics fail or the patient is significantly symptomatic. Chylous effusions are initially managed conservatively, though some require surgery.

Chest tube drainage with antibiotic treatment is warranted in complex parapneumonic effusions or empyema. Intrapleural fibrinolytic and DNase administration can be utilized to enhance drainage. However, thoracoscopic decortication may be necessary when these measures fail.

How is it treated?

Treatment for acute myeloid leukemia is vital. It varies with the patient and stage of the disease. Treatment options include

  • Thoracoscopy
  • Pleurocentesis
  • Thoracotomy : Pulmonologist insert a tube or catheter into your chest to drain the fluid

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