pleural effusion

Def...accumulation of serous fluid bet parietal and visceral pleura
_min flvid requird 4 clinical dtctin of pleu. Efusn is 500ml

¤ClassificaN and Causes

1) Transudate pl. efusn is ultrafiltrate of plasma duo 2 increased hydrostatic pressure oi reducd sr.oncotic press. here pleura is normal
e.g. Ccf, liver cirrhosis, nephrotic syndrome, malnutrition

1) Exudate pleu.efusn is due 2 incrsed capilary permeability. it resembles plasma and rich in protein. Here pleura is diseasd
e.g. TB, malignancy, pneumonia, pul infarction, RA, SLE, pancreatitis, Meigs syndrome, intraabdominal abscess

¤ Clinical features
breathlessness, chest pain, cough, fever

# Physical findings in chest

1) Inspection and palpatiön
shift of trachea and mediastinum to oposit side, reduced chest movment on afected sid, bulging and fulnes of affected chest, reducd chest expansn, markedly reducd vocal fremitus

2)Purcusin
stony dul note oe afected sid, uper level of dulnes is highest in axila lateraly and lower ant. and posteriorly

3) Asculation
intensity of breath sound and vocal resonance markdly reducd or absent on afectd side
Whispering pectoriloquy, aeqophony, tubular bb is audible above d level of pleural efusn

¤ InvestigatioNs
All routine exm
Blood for hb%, tlc, dlc, esr, proteins, sugar, ldh, amylase,

Special

1. radiologcl exam
chst x_ry
PA view_ in erect positn, fl. 300ml
AP vw_supine positn, fl. >300ml
Lateral decubitvs on aff. Side detect fluid vpto 100_150mo

¤ radiologicl features
_obliteration of costophrenic angle
_medstinal sift to oposit side
_dense uniform opacity in lower and lateral part
_uper border of opacity concave and highest lateraly
_phantom tumor

2) Ultrasonography
4 localisatin of pleu. Efu.

3)plural aspiration and flud analysis
_min 50ml fluid shud b withdrwn

4)pleural biopsy with tru_cut needle undr ultrasound guidance

5) other investigations
_Sputum examination 4 tb bacili and malignant cel
_mantoux test
_lymph node biopsy
_bronchoscopy
_thoracoscopy

* Management
1. Rx of undrlying cause
2. Therapeutic aspiration to releive dyspnoea...not more than 1 lit of fld shud b removd at once bcos t cause pul. oedema
3. Pleurodesis for malignant efusion