2. Pleural Fluid/ Effusion
• Pleural fluid is defined as the fluid that is found between the
layers of the pleura, the membranes of which line the cavity and
surround the lungs.
• The space containing the fluid is referred to as the pleural
cavity or pleural space.
• Normal pleural fluid consists of a small amount of a thin
(serous) fluid that functions as a lubricant during breathing.
• Pleural effusion, sometimes referred to as “water on the lungs,”
is the build-up of excess fluid between the layers of the pleura
outside the lungs.
3. • The pleura are thin membranes that line the lungs and the inside of the
chest cavity and act to lubricate and facilitate breathing. Normally, a small
amount of fluid is present in the pleura
• Changes in the volume of pleural fluid can be caused by infection, trauma, or
other causes and can lead to respiratory problems and other adverse conditions.
• Extraction of pleural fluid allows doctors to diagnose causes of these changes or
to investigate for signs of infection or disease.
• When a large amount of pleural fluid is present, it is usually removed due to
symptoms. Often times, however, the fluid recurs, and procedures to prevent
further recurrences are then needed
4. Structure and Function of Pleural Fluid
• Pleural fluid is a thin translucent fluid that fills the cavity between the
parietal (outer) and visceral (inner) pleural layers surrounding the
lungs. The volume of fluid is small, roughly 1-10 ml.
• Pleural fluid functions by lubricating the space between the pleura,
allowing the pleura to glide smoothly during inhalation and
• In this way, it cushions delicate lung tissues against friction from the
ribs and the chest wall itself.
6. Symptoms of pleural effusion
• Some patients with pleural effusion have no symptoms, with the
condition discovered on a chest x-ray that is performed for another
reason. The patient may have unrelated symptoms due to the disease
or condition that has caused the effusion.
• Symptoms of pleural effusion include:
• Chest pain
• Dry, nonproductive cough
• Dyspnea (shortness of breath, or difficult, labored breathing)
• Orthopnea(the inability to breathe easily unless the person is sitting
up straight or standing erect)
7. Causes of Pleural effusion
• Many conditions can cause problems within the pleural cavity and in the
pleural fluid. The following are some of the most common:
• Pleurisy - pleura inflammation, causing sharp pain with breathing; most
commonly caused by a viral infection
• Pleural effusion - excess fluid in the pleural space; commonly from
congestive heart failure or malignancy.
• Pneumothorax - a buildup of air or gas in the pleural space; commonly
from acute lung injury, trauma, or chronic diseases such as a chronic
obstructive pulmonary disease or tuberculosis
• Hemothorax - a buildup of blood in the pleural space; commonly from
injury or trauma to the chest
8. Types of Pleural Fluid
• There are two primary types of pleural fluid found in pleural effusions.
• One is a transudate, which is a thin, clear fluid. Causes of a transudate may include:
• Congestive heart failure
• Chest surgery
• Cirrhosis of the liver
• Pulmonary emboli (blood clots in the legs that break off and travel to the lungs)
• The other type of fluid is an exudate, a thicker, pus-like fluid. an exudate may be found in:
• Cancer (with a malignant pleural effusion)
• Inflammatory or autoimmune diseases such as lupus and rheumatoid arthritis
• Hemothorax (with bleeding into the pleural cavity)
• Chylothorax (when chyle fills the pleural cavity) a milky fluid containing fat droplets which drains from the
lacteals of the small intestine into the lymphatic system during digestion
9. • Other less common causes of pleural effusion include:
• Autoimmune disease
• Bleeding (due to chest trauma)
• Rare chest and abdominal infections
• Asbestos pleural effusion (due to exposure to asbestos)
• Meig’s syndrome (due to a benign ovarian tumor)
• Ovarian hyperstimulation syndrome
• Certain medications, abdominal surgery and radiation therapy may also cause
pleural effusions. Pleural effusion may occur with several types of cancer
including lung cancer, breast cancer and lymphoma. In some cases, the fluid itself
may be malignant (cancerous), or may be a direct result of chemotherapy.
10. How is pleural effusion diagnosed
• The tests most commonly used to diagnose and evaluate pleural effusion include:
• Chest x-ray
• Computed tomography (CT) scan of the chest
• Ultrasound of the chest
• Thoracentesis (a needle is inserted between the ribs to remove a biopsy, or sample of fluid)
• Pleural fluid analysis (an examination of the fluid removed from the pleura space)
• When the pleural effusion has remained undiagnosed despite previous, less-invasive tests,
thoracoscopy may be performed. Thoracoscopy is a minimally invasive technique, also known as
video-assisted thoracoscopic surgery, or VATS, performed under general anesthesia that allows for
a visual evaluation of the pleura). Often, treatment of the effusion is combined with diagnosis in
11. How is pleural effusion treated
• Treatment of pleural effusion is based on the underlying condition and whether
the effusion is causing severe respiratory symptoms, such as shortness of breath
or difficulty breathing.
• Diuretics and other heart failure medications are used to treat pleural effusion
caused by congestive heart failure or other medical causes. A malignant effusion
may also require treatment with chemotherapy, radiation therapy or a
medication infusion within the chest.
• A pleural effusion that is causing respiratory symptoms may be drained using
therapeutic thoracentesis or through a chest tube (called tube thoracostomy).
• Pleural sclerosis performed with sclerosing agents (such as talc, doxycycline, and
tetracycline) is 50 percent successful in preventing the recurrence of pleural
• Pleural effusions that cannot be managed through drainage or pleural sclerosis may require
• The two types of surgery include:
• Video-assisted thoracoscopic surgery (VATS)
• A minimally-invasive approach that is completed through 1 to 3 small (approximately ½ -inch)
incisions in the chest. Also known as thoracoscopic surgery, this procedure is effective in
managing pleural effusions that are difficult to drain or recur due to malignancy. Sterile talc
or an antibiotic may be inserted at the time of surgery to prevent the recurrence of fluid
• Thoracotomy (Also referred to as traditional, “open” thoracic surgery)
• A thoracotomy is performed through a 6- to 8-inch incision in the chest and is recommended
for pleural effusions when infection is present. A thoracotomy is performed to remove all of
the fibrous tissue and aids in evacuating the infection from the pleural space. Patients will
require chest tubes for 2 days to 2 weeks after surgery to continue draining fluid.
• Your surgeon will carefully evaluate you to determine the safest treatment option and will
discuss the possible risks and benefits of each treatment option.
15. What is a blood test
• Regular blood testing is one of the most important ways to keep track of your overall physical
well-being. Getting tested at routine intervals can allow you to see the way your body changes
over time and empower you to make informed decisions about your health.
• What does a blood test show?
• Some blood tests can help your doctor determine how different organs in your body are working.
Examples of organs whose malfunctions can be visible in a blood test include Trusted Source your
thyroid, liver, or kidneys.
• Your doctor can also use blood tests to search for markers of diseases and health conditions such
• coronary heart disease
• Even if a person does not have heart disease, a blood test can show whether they may be at risk
of developing the condition.
16. 1. Complete blood count
• A routine complete blood count (CBC) checks for levels of 10
different components of every major cell in your blood: white
blood cells, red blood cells, and platelets.
• Important components this test measures include red blood cell
count, hemoglobin, and hematocrit.
17. Component Normal range
red blood cells (cells responsible for carrying oxygen
throughout the body)
male: 4.3–5.9 million/mm3; female: 3.5–5.5
white blood cells (immune system cells in the blood) 4,500–11,000/mm3
platelets (the substances that control the clotting of
hemoglobin (protein within the red blood cells that
carries oxygen to organs and tissues, and carbon
dioxide back to the lungs)
male: 13.5–17.5 grams/deciliter
(g/dL); female: 12.0–16.0 g/dL
hematocrit (percentage of blood made of red blood
male: 41–53%; female: 36–46%
18. • Abnormal levels of these components may indicate:
• nutritional deficiencies, such as vitamin B6 or B12
• anemia (iron deficiency)
• clotting problems
• blood cancer
• immune system disorders
19. 2. Basic metabolic panel
• A basic metabolic panel (BMP) usually checks for levels of eight compounds in the blood:
• blood urea nitrogen (BUN)
• This test may require you to fast for at least 8 hours before your blood is drawn, depending on the
instructions of your doctor and what the test is measuring.
• Abnormal results may indicate:
• kidney disease
• hormone imbalances
20. 3. Comprehensive metabolic panel
• A comprehensive metabolic panel (CMP) includes all the measurements of a BMP as well
as additional proteins and substances related to liver function, such as:
• total protein
• alkaline phosphatase (ALP), an enzyme mostly found in the bones and liver that’s
involved in several bodily processes
• alanine aminotransferase (ALT), an enzyme found in the liver
• aspartate aminotransferase (AST), an enzyme found in the liver and other tissues within
• bilirubin, which is waste resulting from the breakdown of red blood cells that the liver
• The same conclusions can be drawn from a CMP as from a BMP for the same
substances that a BMP covers. Other abnormal levels can also indicate underlying
conditions, such as:
21. High levels
• bile duct blockage
• gallbladder inflammation
• Paget’s disease
• bone metabolism disorders
• heart surgery
• zinc deficiency
• liver cancer
• liver damage
• heart conditions
• abnormal red blood cell destruction (hemolysis)
• adverse medication reactions
• bile duct blockage
• Gilbert’s syndrome
not a concern
22. 4. Lipid panel
• This test checks levels of two types of cholesterol:
• high-density lipoprotein (HDL), or “good” cholesterol
• low-density lipoprotein (LDL), or “bad” cholesterol
• HDL is “good” because it removes harmful substances from
your blood and helps the liver break them down into waste. LDL
is “bad” because it can cause plaque to develop in your arteries,
increasing your risk of heart disease.
• You may need to fast for at least 8 hours before this test.
HDL >60 mg/dL
male: <40 mg/dL; female: <50 mg/dL
LDL >160 mg/dL <100 mg/dL (optimal)
23. 5. Thyroid panel
• A thyroid panel, or thyroid function test, checks how well your thyroid is producing and reacting to
certain hormones, such as:
• Triiodothyronine (T3). Along with T4, this regulates your heart rate and body temperature.
• Thyroxine (T4). Along with T3, this regulates your metabolism and how you grow.
• Thyroid-stimulating hormone (TSH). This helps regulate the levels of hormones your thyroid
• Your thyroid is a tiny gland in your neck. It helps regulate bodily functions like your mood, energy
level, and overall metabolism.
• Here are normal results:
• T3: 80–180 nanograms per deciliter of blood (ng/dL)
• T4: 0.8–1.8 ng/dL in adults.
• TSH: 0.5–4 milli-international units per liter of blood (mIU/L)
• Abnormal levels of these hormones can indicate numerous conditions, such as:
• low protein levels
• thyroid growth disorders
• abnormal levels of testosterone or estrogen
24. 6. Cardiac biomarkers
• Enzymes are proteins that help your body accomplish certain chemical processes, such
as breaking down food and clotting blood. They’re used throughout your body for many
• Abnormal enzyme levels can indicate many conditions.
• Common enzymes tested include:
• Creatine kinase (CK). This is an enzyme primarily located in the brain, heart, and
skeletal muscle. When muscle damage happens, CK seeps into the blood in growing
• Creatine kinase-MB (CK-MB). These enzymes are found in your heart. They often
increase in your blood after a heart attack or other heart injury.
• Troponin. This is a heart enzyme that can leak into your blood and results from heart
• Here are the normal ranges for the enzyme listed above:
• CK: 30–200 U/L
• CK-MB: 0–12 IU/L
• troponin: <1 ng/mL
25. 7. Sexually transmitted infection tests
• Many sexually transmitted infections (STIs) can be diagnosed using
a blood sample. These tests are often combined with urine samples
or swabs of infected tissue for more accurate diagnoses.
• The following STIs can be diagnosed with blood tests:
• Blood tests aren’t always accurate right after contracting an infection.
For an HIV infection, for example, you may need to wait at least a
month before a blood test can detect the virus.
26. 8. Coagulation panel
• Coagulation tests measure how well your blood clots and how long it takes
for your blood to clot. Examples include the prothrombin time (PT)
test and fibrinogen activity test.
• Clotting is a crucial process that helps you stop bleeding after a cut or
wound. But a clot in a vein or artery can be deadly since it can block blood
flow to your brain, heart, or lungs. This can cause a heart attack or stroke.
• Coagulation test results vary based on your health and any underlying
conditions that may affect clotting.
• Results from this test can be used to diagnose:
• excessive bleeding (hemophilia)
• liver conditions
• vitamin K deficiency
27. 9. DHEA-sulfate serum test
• The dehydroepiandrosterone (DHEA) hormone comes from your adrenal glands.
This test measures whether it’s too high or too low.
• In men, DHEA helps develop traits like body hair growth, so low levels are
considered abnormal. In women, high levels can cause typically male traits,
like excess body hair, to develop, so low levels are normal.
• Low levels may be caused by:
• Addison’s disease
• adrenal dysfunction
• High levels in men or women can result from:
• congenital adrenal hyperplasia
• benign or malignant tumor on the adrenal gland
• polycystic ovary syndrome (PCOS)
• ovarian tumor
28. 10. C-reactive protein test
• C-reactive protein (CRP) is made by your liver when tissues in your body are inflamed. High
CRP levels indicate inflammation from a variety of causes, including:
• bacterial or viral infection
• autoimmune diseases, such or rheumatoid arthritis
• inflammation related to diabetes
• inflammation related to physical trauma or from habits like smoking
• The higherTrusted Source the level, the higher the risk of heart disease:
• <0.3 mg/dL: normal
• 0.3 to 1.0 mg/dL: minor elevation can be associated with a person’s sex, body mass index
(BMI), or with conditions like depression or insomnia
• 1.0 to 10.0 mg/dL: moderate elevation usually caused by systemic inflammation, such as
from an autoimmune disease, bronchitis, heart attack, or cancer
• >10.0 mg/dL: marked elevation typically caused by a serious bacterial or viral infection, major
trauma, or systemic vasculitis
• >50.0 mg/dL: severe elevation usually caused by an acute bacterial infection