Pleural Effusion

Original Editor - Chelsea McLene

Top Contributors - Chelsea Mclene, Rosie Swift, Kim Jackson, Lucinda hampton, Candace Goh and Khloud Shreif  

Introduction

Definition Pleural effusion is the abnormal accumulation of fluid within the pleural space - the thin cavity between the pleural layers surrounding the lungs.

Causes

• Heart failure
• Pneumonia
• Malignancies (lung cancer)
• Systemic inflammatory disorders (lupus)

Pleural Effusion Classification Summary

Classification Methods:

By underlying cause

• Various etiologies determine the type of effusion

By origin of fluid:

• Serous fluid (hydrothorax) - Clear, watery fluid
• Blood (haemothorax) - Blood in pleural space
• Chyle (chylothorax) - Lymphatic fluid
• Pus (pyothorax) - Infected fluid/pus
• Urine (urinothorax) - Urine in pleural space

Exudative Effusions

Exudative type of pleural effusion requires to be drained. It is formed from extra liquid, protein, blood, inflammatory cells or sometimes bacteria that leak across damaged blood vessels into the pleura.

The causes of this type include pneumonia and lung cancer.

• More protein
• Large amount of cells

Symptoms

• Breathlessness
• Chest pain
• May have cough
• Weakness
• May or may not have fever

Clinical signs

• Auscultation: Pleural rub, reduced breath sounds, reduced vocal resonance
• Reduced chest expansion
• Percussion note: stony dull
• Heart Sounds: Third heart sound can be heard.

Causes

There are many causes, some of them are:

• Congestive heart failure
• Leak from other organs
• Autoimmune conditions: RA, Lupus
• Cancer
• Pulmonary embolism

Diagnosis

• Blood Test: Neutrophilia
• CT Scan
• X-ray: Presence of fluid in the pleural cavity which appears white on X-rays, while air space looks black.Blunting of the costophrenic angle occurs in small collections, where more extensive change on x-ray is seen in larger collections.

Treatment

The principle treatment approach with pleural effusion is to treat the underlying cause.

• Medication: Antibiotics, Diuretics
• Pleural Decortication: Surgeons can operate inside the pleural space, removing inflammation and unhealthy tissue by thoracoscopy or thoracotomy.
• Chemotherapy
• Thoracentesis
• Pleural Biopsy
• Drainage by intercostal tubes
• Pleurodesis

Role of Physiotherapy

Physiotherapy has an important role in stabilising and controlling breathing. It aids in chest fluid drainage and in clearing chest secretions. People who receive respiratory physiotherapy as part of their treatment will tend to achieve a quicker recovery with fewer complications.

Secretion clearance:

• Effective / productive coughing techniques
• Postural drainage in sitting and lying
• Manual assistance, including percussion, vibrations and shaking

Breathing technique retraining:

• Controlling respiratory rate
• Diaphragmatic breathing
• Controlling / reducing breath volume
• Relaxation breathing exercises

Education and Advice:

• Illness cause and progression
• Effects of environmental and allergen factors.
• Medication management

(Read about chest physiotherapy)