Case 1 77 year old woman with hx of copd 2 week history of uri symptoms zpak and then 10 days antibiotics hospitalized with 3 day history of fever to 39. Pleural effusions were classified based on lights criteria, which categorize an effusion as an exudate if it shows one or more of the following features. The latter is the probe most widely used in examining patients with pleural effusion 3. Pleural effusion symptoms, diagnosis and treatment bmj. A range of imaging tools are available to aid the diagnosis of pleural disease and to guide intervention for diagnostic testing or treatment.
Advances in chest imaging provide opportunities to detect parapneumonic effusions with high sensitivity in patients hospitalized. It usually responds to highdose aspirin or steroids. Conventional chest radiography and computed tomography ct scanning are the primary imaging modalities that are used for evaluation of all types of pleural disease, but ultrasound and magnetic resonance. Measurement of a pleural effusion volume with pointofcare ultrasonography may be a useful tool for intensivists and is an active area of research in critical care 7 in controlled settings ultrasound may detect constitutive pleural fluid, can reliably detect effusions 20ml in clinical settings, and may approach the sensitivity and specificity of computed tomography. They may result from a variety of pathological processes which overwhelm the. Malignant pleural effusions with tunneled longterm drainage catheters. Pdf on oct 31, 2018, milic medenica and others published pleural effusions in lung cancer. Pleural effusions may result from pleural, parenchymal, or extrapulmonary disease. A rational diagnostic workup, emphasizing the most common. An ultrasound, chest computed tomography scan, or lateral decubitus study indicates whether the fluid is freeflowing or loculated, and whether or not septations are present. Thoracic ultrasound in the modern management of pleural. The term is usually reserved for collections of serous fluid and therefore excludes hemothorax, chylothorax, and pyothorax empyema. Investigation of pleural effusion of unknown aetiology is well described in british, american and european guidelines. A transudate has a protein content of less than 25gl and an exudate 35gl oxford handbook of clinical medicine 1 lights criteria for pleural effusions.
The modern diagnosis and management of pleural effusions. Any information contained in this pdf file is automatically generated from digital material submitted to epos by third parties in the form of scientific presentations. The first subchapter focuses on the pleural effusion, including types, causes, and identification strategy. Pleural effusion on chest xray this lecture contains two subchapters. Pleural effusions are collections of fluid within the pleural space. This volume may increase as a consequence of numerous pathologic conditions that disrupt the equilibrium of fluid flowing in and out of the pleural space, including congestive heart failure, pneumonia, pleuropulmonary. He had a background of ischaemic heart disease and type 2 diabetes mellitus. According to their composition, most pleural effusions can be classified into two categories. Ordinarily, this space contains 5 to 15 ml of fluid, which prevents friction when the pleural surfaces move. A pleural effusion describes an excess of fluid in the pleural cavity, usually resulting from an imbalance in the normal rate of pleural fluid production or absorption, or both. The mean value in hounsfield units of an effusion was determined using a region of interest on the three slices with the greatest quantity of fluid.
Managing recurrent pleural effusions with an indwelling pleural catheter. Pleural effusions funda ozturk incekara, deniz kaygusuz. It generates a frequency range of 25 mhz which is capable of penetrating up to a depth of 1025 cm from the surface of the skin. Pleural effusion summary radiology reference article. A pleural effusion is a collection of fluid in the pleural space. The etiology of the pleural effusion determines other signs and symptoms. Fluid gathers in the lowest part of the chest, according to the patients position. Pleural effusion, a collection of fluid in the pleural space, is rarely a primary disease process but is usually secondary to other diseases. A possible explanation for the initial pleural effusion was obtained during the followup in eight patients.
In a recent study including 61 patients with ctproven parapneumonic effusions, anteroposterior, posteroanterior, and lateral cxrs all missed approximately 10% of pleural effusions, in most cases due to the. During that admission, the patient fell onto his left side. Pleural effusions are very common, and physicians of all specialties encounter them. The aetiology of the pleural effusion determines other signs and symptoms. Pleural effusion bl or unilateral parapneumonicprocess symptoms. Pleural effusions are abnormal accumulations of fluid within the pleural space.
In so far as it has been possible to determine, similar cases have not heretofore appeared in the literature. The american association for thoracic surgery consensus. Sonographic measurements correlated statistically significantly better with actual effusion volume r. A new, simple method for estimating pleural effusion size.
The physiologic amount of pleural fluid is approximately 5 ml. Pleural effusion in adultsetiology, diagnosis, and treatment. Effusions may cause mass effect on the adjacent lung causing collapse, breathlessness, and respiratory compromise. Pleural effusion is an abnormal collection of fluid in the pleural space between the visceral and parietal pleurae.
The purpose of this report is to describe two cases of encapsulated paramediastinal pleural effusion which strongly simulated mediastinal tumors. Pdf on sep 1, 2007, mohammed a yassin and others published loculated. Pleural disease remains a commonly encountered clinical problem for both general physicians and chest specialists. Malignancy remains the most common cause of unilateral pleural effusion. If the patient is upright when the xray is taken, then fluid will surround the lung base forming a meniscus a concave line obscuring the costophrenic angle and part or all of the hemidiaphragm. A pleural effusion represents the disruption of the normal mechanisms of formation and drainage of fluid from the pleural space. Pleural effusion volume ultrasound radiology reference. Journal of vascular and interventional radiology, 2001. Pleural effusion is fluid buildup in the space between the layers of the pleura. Various kinds of pleural effusion, depending on the nature of the fluid and what caused its entry into the pleural space, are hydrothorax serous fluid, hemothorax blood, urinothorax urine. As the subpulmonic effusion grows in size, it first fills and thus blunts the posterior costophrenic sulcus, visible on the lateral chest.
Encapsulated pleural effusion simulating mediastinal tumor. Pleural effusions may occur in both primary and postprimary tuberculosis. Pleural effusion is commonly used as a catchall term to describe any abnormal accumulation of fluid in the pleural cavity. Posteroanterior chest xray will show an effusion of 200 ml of fluid. There is normally a small amount of fluid between these layers. Detection of pleural effusions in patients at risk. More than 25 ml is considered an effusion, although up to 300 ml may accumulate before symptoms appear.
The maximum thickness of the pleural fluid layer was measured with both modalities, while actual effusion volume was determined by means of complete drainage. Using imaging studies for selecting therapeutic interventions. A delayed etiological diagnosis can be associated with markedly higher morbidity and mortality, e. Pleural effusions and pulmonary opacities are seen in the late stages of lymphoma and must be distinguished from opportunistic infections. Detection and treatment find, read and cite all the research you need on researchgate. Its most common causes are congestive heart failure, cancer, pneumonia, and pulmonary embolism. Three patients 7% eventually recalled having had previous contact with asbestos. Normally, a small amount of fluid is present in the pleura. The pleural space normally contains only about 1020 ml of serous fluid. A pleural effusion is excess fluid that accumulates in the pleural cavity, the fluidfilled space that surrounds the lungs. Pleural effusion has a wide differential diagnosis.
Pleural effusion, sometimes referred to as water on the lungs, is the buildup of excess fluid between the layers of the pleura outside the lungs. Weight loss 15 lbs in one month pf is a transudate. Diagnostic utility and clinical application of imaging for pleural. Radiology plays a crucial role in the evaluation of the pleura. Thoracic ultrasound in the diagnosis of malignant pleural. When the effusion reaches about 300 ml in size, it blunts the lateral costophrenic angle, visible on the frontal chest radiograph. Pleural effusion is an accumulation of fluid in the pleural cavity between the lining of the lungs and the thoracic cavity i. Two larger studies assessed the risk of pneumothorax after thoracentesis with or without ultrasound guidance for all causes of pleural effusion. Since failure to recognize this condition might well lead to the performance. This fluid helps your lungs move easily when you breathe. Tuberculosis is the granulomatous disease that is most likely to present with pulmonary opacities and pleural effusion see fig 4. Radiological investigation of pleural effusion, thickening.
Pleural effusion is the pathologic accumulation of fluid in the pleural space. Conventional radiography, ultrasonography, computerized tomography 3. The pleura is a thin piece of tissue with 2 layers. Etiology, prevalence, and epidemiology pleural effusion is the accumulation of fluid in the pleural space resulting from disruption of the homeostatic forces responsible for the movement of pleural fluid. They may result from a variety of pathological processes which overwhelm the pleuras ability to reabsorb fluid. Chest radiography cxr is still the accepted initial modality for the. Sharma and jay gordonson pulmonary disease service, department of medicine and the department of radiology, university of southern california school of. Chest radiographs are ideally suited to confirm significant pleural effusions but may miss subtle or early pleural disease. Approximately 1 million people develop this abnormality each year in the united states. The pleura are thin membranes that line the lungs and the inside of the chest cavity and act to lubricate and facilitate breathing. Diagnostic utility and clinical application of imaging for. Iatrogenic pleural effusions haemothorax idiopathic pleural effusions diagnostic approach in pleural effusion 1.
Timely diagnosis of pleural space infections and rapid initiation of effective pleural drainage for those patients with complicated parapneumonic effusions or empyema represent keystone principles for managing patients with pneumonia. Pleural effusion explained by prometheus lionhart, md. Radiological investigation of pleural effusion, thickening, masses, and. It is called an exudate if it escapes exudes into the pleural cavity through lesions in.
A metaanalysis of 24 studiesand6,605thoracentesespublishedin. He had been admitted to hospital 6 weeks prior to this presentation with symptoms of congestive cardiac failure. Comparative interpretation of ct and standard radiography. A 37 yearold man with a pleural effusion that resolved slowly in a year stated after 6 months that at the age of 17 years he had had. Pleural effusions are common, with an estimated 11. Estimated prevalence of pleural effusion is 320 cases per 100,000 people in industrialized countries, with a distribution of etiologies related to the prevalence of underlying diseases. Pleural effusion is the accumulation of fluid in the pleural space that results when forces that control the inflow and outflow of the space are disrupted. This excess fluid can impair breathing by limiting the expansion of the lungs.
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