Pleural effusion is the abnormal accumulation of fluid in the pleural space. The pleural space is the space between the lungs and chest cavity and under normal conditions there is a minimum amount of liquid inside.
In the case of accumulation of blood is called hemothorax, and in the case of accumulation of pus, empyema.
Occurs before a mismatch between fluid production and reabsorption. The amount of fluid in the pleural space may not be greater than 15 ml. Otherwise pleural effusion appears.
Depending on the type of pleural fluid characteristics are classified as:
1 – transudates: is the result of an increased intravascular pressure or oncotic pressure of the blood or a combination of both. Are liquids with low concentrations of proteins and cholesterol, and low densities.
They occur mainly in: heart failure (most common cause of transudates), constrictive pericarditis, fluid overload, superior vena cava syndrome, liver cirrhosis, nephrotic syndrome and peritoneal dialysis.
2 – Exudates: are caused by increased permeability of the pleural surface, generally causes inflammatory.Exudates may have different origins: infections (parapneumonic most frequent cause of exudates), cancer, metastasis, pulmonary thromboembolism, pancreatitis, connective (rheumatoid arthritis, systemic lupus erythematosus, Sjögren syndrome, Wegener granulomatosis) drugs (nitrofurantoin, amiodarone, Metrorexate , Metronidazole) and radiotherapy among the most frequent.
Pleural effusion is usually presented as a pleuritic chest pain, ie, by pain, acute and intermittent increases with coughing and deep inspiration. May be associated with cough and fever in the case of exudates.
His most characteristic signs are water dullness to percussion, bombe hemithorax to inspection and decreased transmission of vocal vibrations and breath sounds on auscultation. In some cases it can also auscultate plural blow , compression underlying alveolar lung.
After a complete medical history that includes a thorough anamnesis (history) and physical examination to try to determine the cause of pleural effusion, it is necessary to perform an imaging test such as chest radiography, initially in anteroposterior projection and to doubt diagnostic, in lateral projection on the affected side to see if the liquid moves. The most common radiological image is the effacement of the posterior costophrenic angle (angle between the chest wall and diaphragm) and the typical image, the meniscus of “Damoisseau”.
In some cases the required information can be performed more ultrasound or CT lung, especially in those cases where there are underlying lung disease.
When pleural effusion is very important can shift the mediastinum by the thrust of the liquid. These additional imaging techniques help determine this displacement.
To filial spill source diagnostic thoracentesis is performed, a puncture through the chest to get a sample of pleural fluid for analysis. In cases of small spills and those that appear in the context of congestive heart failure or cirrhosis without fever can be avoided this diagnostic technique.
The thoracentesis fluid analysis on different parameters:
so you can classify it in transudate or exudate to know the cause.
It aims to address the underlying disease that caused the pleural effusion. In cases of pleural produced by heart failure, treatment of the cause (in this case diuretics) is that of choice. In cases of massive spillage and / or usually necessary symptomatic therapeutic thoracentesis, consisting aspiration of fluid with a needle or the placement of a chest tube.
Malignant pleural effusions are treated by chemotherapy or radiotherapy, and in some cases by performing a chemical pleurodesis is between both pleurae instillation of chemicals in order to obliterate the pleural space and prevent fluid from accumulating inside.
Pleural effusion secondary to pneumonia (parapneumonic) usually responds to treatment with systemic antibiotics. If pleural effusions following pneumonia complicated (complicated parapneumonic or empyema) requires the placement of a chest tube for resolution.
Hemothorax: accumulation of blood is in the plural space. The most common cause is trauma, which can be produced by accident or by some maneuver iatrogenic invasive diagnostic or spontaneously. Clinically, it presents as acute onset chest pain with hypotension and anemia. Chest radiography shows a partial or total opacity of the hemithorax affection and thoracentesis is who will confirm the diagnosis. Treatment aims to treat the underlying disease and evacuate the hemothorax through a drain pipe. In severe cases it may be necessary to perform a thoracotomy.
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