Pleural Effusion: Difference between revisions
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== Introduction == | == Introduction == | ||
Pleural effusion is a collection of an unusual amount of fluid in the pleural cavity. <ref name=":1">Light RW | Pleural effusion is a collection of an unusual amount of fluid in the pleural cavity. <ref name=":1">Light RW. [https://www.nejm.org/doi/full/10.1056/NEJMcp010731 Pleural effusion]. New England Journal of Medicine. 2002 Jun 20;346(25):1971-7.</ref> | ||
The [[Lung Anatomy|pleura]] are two continuous membranes which form a sac to enclose each lung. When fluid builds up in the space between the layers of pleura, a pleural effusion has occurred. | The [[Lung Anatomy|pleura]] are two continuous membranes which form a sac to enclose each lung. When fluid builds up in the space between the layers of pleura, a pleural effusion has occurred. | ||
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Most common cause of this type is [https://www.physio-pedia.com/Introduction_to_Congestive_Heart_Failure congestive heart failure]. | Most common cause of this type is [https://www.physio-pedia.com/Introduction_to_Congestive_Heart_Failure congestive heart failure]. | ||
* Less protein | * Less protein | ||
* Few cells<ref name=":2">Light RW, Macgregor MI, Luchsinger PC, Ball WC | * Few cells<ref name=":2">Light RW, Macgregor MI, Luchsinger PC, Ball WC. [https://semanticscholar.org/paper/a19f8e462b613741559ec919dcbd3837786a175e Pleural effusions: the diagnostic separation of transudates and exudates"]. 1972. Ann Intern Med. 77 (4): 507–13.</ref> | ||
==== Exudative ==== | ==== Exudative ==== | ||
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* [[Blood Tests|Blood Test]]: Neutrophilia | * [[Blood Tests|Blood Test]]: Neutrophilia | ||
* [[CT Scans|CT Scan]] | * [[CT Scans|CT Scan]] | ||
* [https://www.physio-pedia.com/X-Rays X-ray]: Presence of fluid in the pleural cavity which appears white on X-rays, while air space looks black.<ref>Corne; et al. (2002). | * [https://www.physio-pedia.com/X-Rays X-ray]: Presence of fluid in the pleural cavity which appears white on X-rays, while air space looks black.<ref>Corne; et al. (2002). [https://scholar.google.com/scholar_url?url=https://epos.myesr.org/esr/viewing/index.php%3Fmodule%3Dviewing_poster%26task%3D%26pi%3D138426&hl=en&sa=T&oi=gsb&ct=res&cd=0&d=3713063537200917663&ei=2V9bYNGpBJ-R6rQPps2BmAE&scisig=AAGBfm1CoKxrqXCaKSl7OWE_6KWkFgPmAQ Chest X-Ray Made Easy]. Churchill Livingstone. ISBN .</ref><ref>Sahn SA, Heffner JE. [https://books.google.com/books?hl=en&lr=&id=WiPSBQAAQBAJ&oi=fnd&pg=PA209&ots=BH4yCZANrx&sig=BTCeZBy8UPmhNHNYmKaKa_0Q67I Pleural fluid analysis]. Textbook of pleural diseases. 2008 Apr 25;2:209-6.</ref> | ||
== Treatment == | == Treatment == | ||
The principle treatment approach with pleural effusion is to treat the underlying cause. | The principle treatment approach with pleural effusion is to treat the underlying cause. | ||
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* Pleural Decortication: Surgeons can operate inside the pleural space, removing inflammation and unhealthy tissue by thoracoscopy or [[thoracotomy]]. | * Pleural Decortication: Surgeons can operate inside the pleural space, removing inflammation and unhealthy tissue by thoracoscopy or [[thoracotomy]]. | ||
* Chemotherapy | * Chemotherapy | ||
* [[Thoracentesis]] <ref>de Menezes Lyra R | * [[Thoracentesis]] <ref>de Menezes Lyra R. [https://scholar.google.com/scholar_url?url=https://journal.chestnet.org/article/S0012-3692(15)47196-X/abstract&hl=en&sa=T&oi=gsb&ct=res&cd=0&d=4801023564618924139&ei=d19bYJP0A4nSyQT5jLPoCQ&scisig=AAGBfm0tVOHRr6CWuXd5Ek4MG83Raihwew A modified outer cannula can help thoracentesis after pleural biopsy] (PDF). Chest. 1997. 112(1):296</ref> | ||
* Pleural Biopsy | * Pleural Biopsy | ||
* [https://physio-pedia.com/Chest_Drains?utm_source=physiopedia&utm_medium=related_articles&utm_campaign=ongoing_internal Drainage] by intercostal tubes | * [https://physio-pedia.com/Chest_Drains?utm_source=physiopedia&utm_medium=related_articles&utm_campaign=ongoing_internal Drainage] by intercostal tubes | ||
| Line 77: | Line 77: | ||
* Breathing technique retraining: | * Breathing technique retraining: | ||
** Controlling respiratory rate | ** Controlling respiratory rate | ||
** [https://www.physio-pedia.com/Diaphragmatic_Breathing_Exercises Diaphragmatic breathing] | **[https://www.physio-pedia.com/Diaphragmatic_Breathing_Exercises Diaphragmatic breathing] | ||
** Controlling / reducing breath volume | ** Controlling / reducing breath volume | ||
** Relaxation breathing exercises | ** Relaxation breathing exercises | ||
| Line 83: | Line 83: | ||
** Illness cause and progression. | ** Illness cause and progression. | ||
** Effects of environmental and allergen factors. | ** Effects of environmental and allergen factors. | ||
** Medication management | ** Medication management | ||
(Read about [https://www.physio-pedia.com/Chest_Physiotherapy chest physiotherapy]) | (Read about [https://www.physio-pedia.com/Chest_Physiotherapy chest physiotherapy]) | ||
Revision as of 11:16, 22 March 2022
Original Editor - Chelsea McLene
Top Contributors - Chelsea Mclene, Rosie Swift and Kim Jackson
Introduction[edit | edit source]
Pleural effusion is a collection of an unusual amount of fluid in the pleural cavity. [1]
The pleura are two continuous membranes which form a sac to enclose each lung. When fluid builds up in the space between the layers of pleura, a pleural effusion has occurred.
Normally, for smooth movement of lungs, only teaspoons of watery fluid are in the pleural space.[2]
Classification[edit | edit source]
By Pathophysiology[edit | edit source]
Transudative[edit | edit source]
Transudative type of pleural effusion rarely needs to be drained. It is formed from the liquid which leaks around the pleura.
Most common cause of this type is congestive heart failure.
- Less protein
- Few cells[4]
Exudative[edit | edit source]
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[4]
By the underlying cause[edit | edit source]
By the origin of the fluid[edit | edit source]
- Serous fluid (hydrothorax)
- Blood (haemothorax)
- Chyle (chylothorax)
- Pus (pyothorax)
- Urine (urinothorax)
Symptoms[edit | edit source]
- May or may not have fever
- May have cough
- Breathlessness
- Chest pain
- Pleural rub
- Heart Sounds: Third heart sound can be heard.
- Weakness
Causes[edit | edit source]
There are many causes, some of them are:
Diagnosis[edit | edit source]
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- 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.[6][7]
Treatment[edit | edit source]
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 [8]
- Pleural Biopsy
- Drainage by intercostal tubes
- Pleurodesis
Role of Physiotherapy[edit | edit source]
Physiotherapy has an important role in stabilizing 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)
References[edit | edit source]
- ↑ 1.0 1.1 Light RW. Pleural effusion. New England Journal of Medicine. 2002 Jun 20;346(25):1971-7.
- ↑ Rajgaria A. PLUERAL EFFUSION-DISEASE OF LUNGS. [last accessed 24/03/2021]
- ↑ Armando Hasudungan. Pleural Effusion (DETAILED) - (pathophysiology, signs and symptoms, treatment). Available from: https://www.youtube.com/watch?v=f6bngHjMLA0 [last accessed 24/3/2021]
- ↑ 4.0 4.1 Light RW, Macgregor MI, Luchsinger PC, Ball WC. Pleural effusions: the diagnostic separation of transudates and exudates". 1972. Ann Intern Med. 77 (4): 507–13.
- ↑ Light RW. Pleural effusions. Medical Clinics. 2011 Nov 1;95(6):1055-70.
- ↑ Corne; et al. (2002). Chest X-Ray Made Easy. Churchill Livingstone. ISBN .
- ↑ Sahn SA, Heffner JE. Pleural fluid analysis. Textbook of pleural diseases. 2008 Apr 25;2:209-6.
- ↑ de Menezes Lyra R. A modified outer cannula can help thoracentesis after pleural biopsy (PDF). Chest. 1997. 112(1):296
