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| ==Treatment== | | ==Treatment== |
| ===Physical Examination===
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| When only 250 to 300ml of pleural fluid is present, physical examination may be unremarkable.
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| At a pleural fluid volume of approximately 500 ml, the typical physical findings are:<ref name="isbn0-7817-6957-4">{{cite book | author = Light, Richard J. | authorlink = | editor = | others = | title = Pleural diseases | edition = | language = | publisher = Lippincott Williams & Wilkins | location = Hagerstwon, MD | year = 2007 | origyear = | pages = | quote = | isbn = 0-7817-6957-4 | oclc = | doi = | url = | accessdate = }}</ref>
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| * Dullness to [[percussion]]
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| * Decreased [[fremitus]]
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| * Normal vesicular [[breath sounds]] of decreased intensity compared with the contralateral side
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| At a pleural fluid volume exceeding 1000ml, there usually is:<ref name="isbn0-7817-6957-4">{{cite book | author = Light, Richard J. | authorlink = | editor = | others = | title = Pleural diseases | edition = | language = | publisher = Lippincott Williams & Wilkins | location = Hagerstwon, MD | year = 2007 | origyear = | pages = | quote = | isbn = 0-7817-6957-4 | oclc = | doi = | url = | accessdate = }}</ref>
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| * Absence of inspiratory retraction and mild bulging of the intercostal spaces
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| * Decreased expansion of the ipsilateral chest wall
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| * Dullness to [[percussion]] up to the level of the scapula and axilla
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| * Decreased or absent [[fremitus]] posteriorly and laterally
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| * Bronchovesicular [[breath sounds]], which may be of decreased intensity at the upper level of the effusion
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| * [[Egophony]] at the upper level of the effusion
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| When the effusion fills the entire hemithorax, physical examination will show:<ref name="isbn0-7817-6957-4">{{cite book | author = Light, Richard J. | authorlink = | editor = | others = | title = Pleural diseases | edition = | language = | publisher = Lippincott Williams & Wilkins | location = Hagerstwon, MD | year = 2007 | origyear = | pages = | quote = | isbn = 0-7817-6957-4 | oclc = | doi = | url = | accessdate = }}</ref>
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| * Bulging of the intracostal spaces
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| * Minimal to no expansion of the ipsilateral chest wall
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| * A dull or flat [[percussion]] noted over the entire hemithorax
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| * Absent [[breath sounds]] over the majority of the chest with possible bronchovesicular bronchial [[breath sounds]] at the apex
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| * [[Egophony]] at the upper level of the pleural effusion
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| * Apalpable liver or spleen due to significant diaphragmatic depression
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| ==References== | | ==References== |
| {{Reflist|2}} | | {{Reflist|2}} |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Template:GCC
Overview
Pleural effusion is the presence of excessive fluid in the pleural cavity resulting from transudation or exudation from the pleural surfaces.
In normal conditions, the pleural space contains a small amount of fluid (≈0.3 mL·kg-1) maintained by a complex interplay of hydrostatic pressures and lymphatic drainage, which allows for steady liquid and protein turnover.[1] Pathological processes may lead to the development of pleural effusions by causing disequilibrium between the rates of pleural fluid formation, pleural permeability and pleural fluid absorption.
Four types of fluids can accumulate in the pleural space:
Pathophysiology
Healthy individuals have less than 15 ml of fluid in each pleural space. Normally, fluid enters the pleural space from the capillaries in the parietal pleura, from interstitial spaces of the lung via the visceral pleura, or from the peritoneal cavity through small holes in the diaphragm. This fluid is normally removed by lymphatics in the visceral pleura, which have the capacity to absorb 20 times more fluid than is normally formed. When this capacity is overwhelmed, either through excess formation or decreased lymphatic absorption, a pleural effusion develops.
Treatment
References
- ↑ Miserocchi G (1997). "Physiology and pathophysiology of pleural fluid turnover". Eur. Respir. J. 10 (1): 219–25. PMID 9032518.
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