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View Full Version : Pleural Effusion ( Causes - C/P - Investigations - Treatment )



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03-18-2009, 10:34 AM
Pleural Effusion
Aetiology 1- Transudate * Heart failure
* Nephritic $
* Liver cirrhosis
2- Bloody * TB
* Malignancy
3- Chylous obstruction of thoracic duct
4- Exudate *lry mostly T.B.
*2 ry due to Lung disease
Mediastinal As before
Subdiaphragmatic
Chest wall
C/P Symptom
General Toxic symptoms, manifestation
of the cause.
Local Cough
Dyspnea
Dull aching pain

Signs 1- Inspection movement absent Littin sign.
2- Palpation Trachea shifted
TVF
3- Percussion Stony dullness
4- Auscultation diminished air entery.
N.B. percussion in pleural effusion:
* Skodiac resonance in upper part of lung due to compensatory
emphysema.
* Dullness just above the level of effusion due to lung collapse.






Investigation
1. X-ray chest: homogenous opacity with obliteration of costophrenic angle
2. Pleural biopsy for Malignancy
T .B.
3. Aspiration Transudate
Exudate:
Protein > 3gm %
Specific gravity> 1018
Cells
LDH > 200 IU/L

Other finding in pleural effusion
1- glucose TB
Rheumatoid disease
2- ­­ amylase pancreatitis!?
3- C3, C4 e.g. SLE
4- R.B.Cs ­­ malignancy.
T.B
5- LDH ­­ with exudate.
6- Malignant Cells malignancy
7- Z.N. for T.B.
8- PH ↓ with empyema.
9- PL fluid protein / serum protein > 0.5

Treatment of pleural effusion
1- Treatment of the cause
2- Aspiration:

diagnostic therapeutic
◘ as ascites ◘ to dyspnea
◘ to incidence of fibrosis especially in T.B.

Source: Internal Medicine Book of Dr.Osama Mahmoud (Ain Shams University)