2. • Pleural effusion, a collection of ﬂuid in the pleural
space, is rarely a primary disease process but is
usually secondary to other diseases. Normally, the
pleural space contains a small amount of ﬂuid (5 to
15 mL), which acts as a lubricant that allows the
pleural surfaces to move without friction.
• Normally pleural space contains a thin layer of
• Fluid enters the pleural space from the capillaries in
the parietal pleural and is removed by the
lymphatics in the parietal pleura.
• Fluid can also enter the pleural space from the
interstitial spaces of the lung via the visceral pleura
or from the peritoneal cavity through the
5. • Transudative effusion occurs commonly due to
systemic factors which either increase the
hydrostatic pressure or decrease the plasma
• Exudative effusion occurs due to local pathology in
the lung or the pleura.
9. Clinical Features
• Chest pain (pleurisy)
• Symptoms associated with the actual cause of pleural
• Renal disorder, Cardiac and liver disease
• Risk for thromboembolism
• Exposure to asbestos (occupation)
• Trachea shifted to opposite side
• Chest movements decreased
• Stony dullness
• Absent breath sounds.
• crackles may be present.
• Decreased vocal resonance and fremitus on same side
• Chest X ray
• CT scan
• Pleural ﬂuid is analyzed by bacterial culture, Gram
stain, acidfast bacillus stain (for TB), red and white
blood cell counts, chemistry studies (glucose,
amylase, lactic dehydrogenase, protein), cytologic
analysis for malignant cells, and pH.
• A pleural biopsy also may be performed
12. MANAGEMENT OF PLEURAL
Treatment of underlying cause
Therapeutic aspiration/thoracentesis is necessary
in order to relieve dyspnoea
Removing more than 1L in one episode in inadvisable
Can result in re-expansion pulmonary oedema
Should never be aspirated to dryness before the exact
etiology is determined
14. • Other treatments for malignant pleural effusions
• surgical pleurectomy,
• insertion of a small catheter attached to a drainage
bottle for outpatient management, or
• implantation of a pleuroperitoneal shunt.