Presentation
It is present in various forms but its manifestation as pleural effusion is rare. Here, we describe a case of 58-year-old male who presented with complaint of left side chest pain and breathlessness. [ncbi.nlm.nih.gov]
A thin layer of fluid is always present in this space for lubrication and ease of movement of the lung during inspiration and expiration. [bestpractice.bmj.com]
Entire Body System
- Pain
To the authors' knowledge, itinerant chest pain has not been reported as sign or symptom of PE. A 41-year-old woman presenting with left chest pain, no hemoptysis, or breathing difficulties. The chest pain was more severe on deep inspiration. [ncbi.nlm.nih.gov]
pain, anorexia, elevated amylase and lipase levels, nausea, vomiting Post-abdominal surgery Exudative Recent surgery Genitourinary Endometriosis Exudative Dysmenorrhea, infertility, pelvic pain Meigs syndrome Exudative History of ovarian tumor Ovarian [aafp.org]
Pain is usually felt over the inflamed site, but referred pain is possible. [merckmanuals.com]
However, the pain may be felt also or only in the upper abdominal region or neck and shoulder, which is called referred pain (see figure What Is Referred Pain?). Pleuritic pain can be caused by disorders other than pleural effusion. [msdmanuals.com]
- Fever
Symptoms Cough Pleuritic Chest Pain Tachypnea Low grade fever Red flags Weight loss Hemoptysis Fever Low grade fever may be seen in non-infectious cause IV. [fpnotebook.com]
A 68-year-old woman was admitted to our hospital with fever and pleural effusion. Her thoracentesis showed eosinophilic pleural effusion (EPE) without any evidence of malignancy, infection, or trauma. [ncbi.nlm.nih.gov]
nausea, vomiting Cirrhosis Transudative History of alcohol abuse or viral hepatitis; ascites, caput medusae, palmar erythema Esophageal perforation Exudative History of esophageal tumor or reflux; chest or abdominal pain, fever Pancreatitis Exudative [aafp.org]
Less common causes include untreated hemothorax that becomes infected ;, ruptured lung abscess, esophageal tear, or thoracic trauma (e.g., thoracic surgery) Clinical features Pleuritic chest pain Shortness of breath Low-grade fever Cough Diagnosis Chest [amboss.com]
- Inflammation
This condition may result from heart failure, cancer, pulmonary embolism, or inflammation. [healthcommunities.com]
If the pleura is aggravated in any way—through pressure, inflammation, irritation, swelling—the body will start producing pleural fluid in abnormal amounts. [urmc.rochester.edu]
Uncomplicated pleural effusions contain fluid without signs of infection or inflammation. They’re much less likely to cause permanent lung problems. Complicated pleural effusions, however, contain fluid with significant infection or inflammation. [healthline.com]
- Congestive Heart Failure
Although Light's criteria correctly identified all of the exudates, five patients with congestive heart failure were misclassified as exudates. [ncbi.nlm.nih.gov]
Congestive heart failure → raised systemic venous pressures (right-sided), or left sided failure Heart: congestive heart failure : Cardiomyopathy Heart: dilated cardiomyopathy (DCM). Congenital cardiac defects. [vetstream.com]
[…] in congestive heart failure, or kidney and liver disease). [cardiachealth.org]
Bilateral effusions with an enlarged cardiac silhouette are most likely due to congestive heart failure. [emedicine.medscape.com]
- Collapse
At her last presentation, non-contrast-enhanced chest CT showed a pleural effusion and a lower left hemithorax mass, both large enough to cause complete collapse of the lower lobe and partial collapse of the upper lobe. [ncbi.nlm.nih.gov]
A pneumothorax is the accumulation of air in the pleural space, and is commonly called a "collapsed lung." (en) [dbpedia.org]
A Pleural Effusion is often associated with atelectasis (collapse of lung tissue ): Atelectasis is an abnormal condition characterized by the collapse of lung tissue, preventing the respiratory exchange of carbon dioxide and oxygen. [cardiachealth.org]
Respiratoric
- Pleural Effusion
[…] disease Exudative[edit] Pleural effusion Anteroposterior Chest X-ray of a pleural effusion. [en.wikipedia.org]
Eosinophilic pleural effusion (EPE) is an eosinophil count ≥10% in pleural effusion, which is a rare condition in drug therapy. [ncbi.nlm.nih.gov]
Pleural Effusions I. Problem/Condition. A pleural effusion is an abnormal accumulation of pleural fluid within the pleural space. [clinicaladvisor.com]
Medication-associated effusion The location of the pleural effusion can help in the differential diagnosis. [emedicine.medscape.com]
- Pneumonia
Mycoplasma pneumoniae is a common cause of community-acquired pneumonia. As M. pneumoniae pneumonia is usually a mild and self-limiting disease, complications such as pleural effusion occur only rarely. [ncbi.nlm.nih.gov]
It starts with pneumonia Pleural effusion (PE) doesn’t begin as a life-threatening illness, but may arise as a severe complication of pneumonia. [lungtx.com]
- Cough
Therapeutic thoracocentesis with nearly complete removal of the fluid collection alleviates dyspnoea and cough in most circumstances. [bestpractice.bmj.com]
Symptoms include shortness of breath, cough, and chest pain. [icd9data.com]
Symptoms of Pleural Effusions The most common symptoms, regardless of the characteristics of the fluid or the underlying cause, include: Shortness of breath or rapid breathing Sharp chest pain that is worse with cough or deep breath Cough Hiccups Collapsed [urmc.rochester.edu]
We report a 22-year-old woman who presented to the Emergency Medicine Department of the Sultan Qaboos University Hospital, Muscat, Oman, in 2017 with an eight-day history of fever associated with coughing, chills and rigors. [ncbi.nlm.nih.gov]
A pleural effusion may cause you to cough or feel short of breath. You may breathe faster than usual. You may have mild to severe chest pain that starts or gets worse when you breathe in or cough. [drugs.com]
- Dyspnea
CASE PRESENTATION: An 84-year-old Japanese non-smoking woman with a history of lung cancer, treated by surgery, was admitted due to gradual worsening of dyspnea that had occurred over the previous month. [ncbi.nlm.nih.gov]
Signs and symptoms of an effusion vary depending on the underlying disease, but dyspnea, cough (usually nonproductive), and pleuritic chest pain are common. [journals.lww.com]
If dyspnea caused by malignant pleural effusion is relieved by thoracentesis but fluid and dyspnea redevelop, chronic (intermittent) drainage or pleurodesis is indicated. [merckmanuals.com]
Patients can be asymptomatic or can present with cough, dyspnea, and pleuritic chest pain. Dullness to percussion on physical examination suggests an effusion; chest radiography can confirm the diagnosis. [aafp.org]
- Dry Cough
On arrival (7 February 2015), she was febrile to 40.3 °C with a brutal flu syndrome, chills, dry cough and serous rhinitis, for which she received symptomatic treatment. A biological assessment was done that confirmed the clinical diagnosis of flu. [ncbi.nlm.nih.gov]
Symptoms Signs and Symptoms of Pleural Effusion Some people can have pleural effusion without any symptoms, but those who do have signs and symptoms may experience the following: Chest pain Dry cough Fever Shortness of breath Inability to breathe easily [loyolamedicine.org]
People with a pleural effusion may experience the following symptoms: Shortness of breath Dry cough Pain Feeling of chest heaviness or tightness Inability to lie flat Inability to exercise Generally feeling unwell Diagnosing pleural effusion Your doctor [cancer.net]
it may induce compression symptoms such as persistent dry cough, chest pain, increased dyspnea, or chest heaviness sensation. [ejbronchology.eg.net]
Gastrointestinal
- Vomiting
[…] viral hepatitis; ascites, caput medusae, palmar erythema Esophageal perforation Exudative History of esophageal tumor or reflux; chest or abdominal pain, fever Pancreatitis Exudative Abdominal pain, anorexia, elevated amylase and lipase levels, nausea, vomiting [aafp.org]
Aspiration pneumonia Aspiration pneumonia occurs when you inhale food, drink, vomit or saliva into your lungs. [mayoclinic.org]
Coughing and vomiting. Pathophysiology Fluid accumulation in pleural space → lung lobes unable to expand → dyspnea. True transudates associated with hypoproteinemia. [vetstream.com]
The most severe form is caused by P. falciparum; variable clinical features include fever, chills, headache, muscular aching and weakness, vomiting, cough, diarrhoea and abdominal pain. [who.int]
Cerebral malaria Algid malaria: characterized by severe vomiting, diarrhea and circulatory collapse. The pulse is rapid and of poor volume, and arterial hypotension is profound. [infectiousdiseaseadvisor.com]
- Loss of Appetite
[…] of appetite Shortness of breath with exertion and possibly at rest Swelling of the legs, arms, or face Weight loss Diagnosis If we suspect that you have pleural effusion, we will conduct a physical examination and order tests to confirm the diagnosis [utswmed.org]
When symptoms are present, they can include chest pain, difficult or painful breathing (especially deep breathing), coughing, fever, chills, loss of appetite, and hiccups. [study.com]
He had subjective weight loss over the past 10 days due to loss of appetite, but no shortness of breath at rest, chest pain, fevers, or sick contacts. He had never smoked and had no known past exposures to TB. [rc.rcjournal.com]
Cardiovascular
- Heart Failure
This situation most commonly is seen in patients with heart failure. The disappearance of the apparent mass when the heart failure is treated definitively establishes the diagnosis of pseudotumor (i.e., vanishing tumor). [aafp.org]
Although Light's criteria correctly identified all of the exudates, five patients with congestive heart failure were misclassified as exudates. [ncbi.nlm.nih.gov]
The Rational Clinical Examination Series review found that bilateral effusions, symmetric and asymmetric, are the most common distribution in heart failure (60% of effusions in heart failure will be bilateral). [en.wikipedia.org]
Congestive heart failure → raised systemic venous pressures (right-sided), or left sided failure Heart: congestive heart failure : Cardiomyopathy Heart: dilated cardiomyopathy (DCM). Congenital cardiac defects. [vetstream.com]
- Chest Pain
To the authors' knowledge, itinerant chest pain has not been reported as sign or symptom of PE. A 41-year-old woman presenting with left chest pain, no hemoptysis, or breathing difficulties. The chest pain was more severe on deep inspiration. [ncbi.nlm.nih.gov]
Patients predominantly present with breathlessness but cough and pleuritic chest pain can be a feature. The aetiology of the pleural effusion determines other signs and symptoms. Postero-anterior CXR will show an effusion of >200 mL of fluid. [bestpractice.bmj.com]
pain, fever, unilateral effusion) Suspected transudative bilateral effusions with atypical features (e.g., fever, pleuritic chest pain, effusions of disparate size) Technique : Ultrasound -assisted (if possible) dorsal puncture with the patient sitting [amboss.com]
Symptoms Pleurisy typically causes a sharp chest pain (pleuritic chest pain) that worsens with breathing in or coughing. The pain may start and remain in one specific area of the chest wall, or it may spread to the shoulder or back. [health.harvard.edu]
- Cyanosis
Symptoms of pneumothorax include: Sudden sharp pain that worsens with deep breathing Shortness of breath Chest tightness Fatigue Fast heart rate Bluish skin color (called cyanosis) Symptoms of hemothorax may include: Chest pain Shortness of breath Respiratory [bmc.org]
Presence or absence of cyanosis, particularly perioral, enlarged jugular veins. Any audible sounds associated with breathing, wheezes, stridor, that one can hear without the stethoscope. Paradoxical abdominal wall movement. [clinicaladvisor.com]
Musculoskeletal
- Arthritis
Arthritis Rheum 2009;61:108-18. [Table 1] [jacpjournal.org]
Here we report the case of a 61-year-old man with rheumatoid arthritis (RA) who developed a large right-sided pleural effusion and was successfully treated with abatacept. [ncbi.nlm.nih.gov]
Weitere Titelhinweise 1=56,2,2; 2=57,2,2; 3=59,1,2; 4=59,5,2; 5=60,2,2; 6=60,5,2; 8=71,5,2; 7=67,3,2 von: Annals of internal medicine 1=14; 4=15; 6=16 von: Rheumatism and arthritis Standardnummern ISSN der Vorlage: 0003-4819; 0570-183X OCLC-Nr.: 183357811 [zdb-katalog.de]
Autoimmune disease, especially rheumatoid arthritis. Asbestos exposure. Pancreatitis. Complication of acute myocardial infarction (Dressler's syndrome). [patient.info]
Abdomen Hepatomegaly or Splenomegaly (CHF, malignancy) Ascites ( Cirrhosis ) Hemeonc Lymphadenopathy (malignancy) Primary cancer site ( Breast, colon, Prostate, skin) Weight loss (malignancy) Musculoskeletal Joint exam for arthritic changes ( Rheumatoid Arthritis [fpnotebook.com]
Psychiatrical
- Suggestibility
Pleural plaques and calcifications may be seen, suggesting history of asbestos exposure. [patient.info]
An exudate tends to suggest a local process adjacent to or involving the pleura, whereas a transudate suggests a systemic process. [emedicine.medscape.com]
A clinical examination showed lymphocytic pleura effusion and elevated serum IgG4 levels, so that IgG4-related disease was suggested, whereas tuberculous pleurisy was suspected because of high adenosine deaminase (ADA) levels in the pleural effusion. [ncbi.nlm.nih.gov]
A low pleural fluid glucose (<60 mg/dl) or pleural fluid to serum glucose ratio less than 0.5 suggests the same diagnoses that are suggested by a low pleural fluid pH. [pulmonologyadvisor.com]
Thus, the finding of neutrophilrich fluid heightens suspicion for parapneumonic pleural effusion (an acute process), whereas a lymphocyte-predominant fluid profile suggests cancer or tuberculosis (a chronic process). [aafp.org]
- Aggressive Behavior
BACKGROUND/AIM: Clear cell sarcoma (CCS) of soft tissue is exceedingly rare and frequently exhibits aggressive behavior. [ncbi.nlm.nih.gov]
Urogenital
- Kidney Failure
Pulmonary embolism Trauma Uremia or kidney failure Symptoms Symptoms that are associated with a pleural effusion include: Anxiety Chest pain Chest pressure Cough Fatigue Fever Loss of appetite Shortness of breath with exertion and possibly at rest Swelling [utswmed.org]
A pleural effusion can be caused by many different conditions, including: heart failure infections such as pneumonia kidney failure liver disease low blood protein levels blockage of a major blood vessel cancer chest injury Pleural effusion is different [healthdirect.gov.au]
Rare causes — Radiation therapy (for cancer), a collapsed lung (pneumothorax) and pericarditis (as with severe kidney failure or following a heart attack) all can be associated with pleurisy. [health.harvard.edu]
Examples of transudate pleural effusions include: Congestive heart failure Liver failure or cirrhosis Kidney failure or nephritic syndrome Peritoneal dialysis Exudate pleural effusions are caused by inflammation of the pleura, and are often due to disease [emedicinehealth.com]
In general, effusions may be caused by congestive heart failure, kidney failure, kidney disease, low albumin levels in the blood, infection, cancer, a pulmonary embolism, cirrhosis of the liver, an injury or trauma, pneumonia, or an autoimmune disease [study.com]
- Renal Insufficiency
Mostly effusion in SSc is exudative but can be transudative due to chronic renal insufficiency or accompanying heart failure. [31], [32] Recurrent spontaneous pneumothorax can occur due to the frequent presence of subpleural cysts. [33] Mixed Connective [jacpjournal.org]
Normally the PL is an exudate, but occasionally the effusion is not due to SS itself but instead of chronic renal insufficiency or accompanying heart failure, and therefore could behave as a transudate. 75,76 In a postmortem study, pleural thickening [archbronconeumol.org]
- Renal Function Impairment
After Cox proportional hazard regression analysis adjusted by patient gender, age, complications of cirrhosis and comorbid disorders, old age, esophageal variceal bleeding, hepatocellular carcinoma, hepatic encephalopathy, pneumonia, renal function impairment [ncbi.nlm.nih.gov]
Workup
Echocardiogram showed ejection fraction of 45% and cardiac workup for sarcoid involvement was negative. [ncbi.nlm.nih.gov]
It can save the clinician significant time and avoid unnecessary additional workup. Remember, however, that Light’s criteria is more sensitive than specific test for exudative effusions. [mdcalc.com]
If the etiology of the exudate is still unknown after the above workup, then a pleural biopsy is generally indicated. This procedure can be done through various methods, such as image-guided needle biopsy or thoracoscopic biopsy. [clinicaladvisor.com]
Pleural effusion workup. In: Soo Hoo GW, ed. Medscape. Updated October 15, 2021. Accessed January 10, 2022. https://emedicine.medscape.com/article/299959-workup#showall D’Agostino HP, Edens MA. Physiology, pleural fluid. In: StatPearls. [labtestsonline.it]
If FLDH rather than TPR had been used as the sole diagnostic test in our series of 200 patients, one fewer patient would have been subjected to further diagnostic workup. [doi.org]
X-Ray
- Atelectasis
Atelectasis – a collapsed or airless state of the lung – may be acute or chronic, and may involve all or part of the lung. The primary cause of atelectasis is obstruction of the bronchus serving the affected area. [cardiachealth.org]
Arterial blood gases, pleural effusion, and atelectasis were compared between groups. Atelectasis and pleural effusion was reduced in experimental group. [ncbi.nlm.nih.gov]
This cannot be atelectasis from compression - it is pneumonia with an associated effusion. A massive effusion. The depth between the pleura is 6cm. [icmteaching.com]
Types of disorders that can cause transudative effusions include congestive heart failure, cirrhosis, and atelectasis. It is also associated with some medical procedures, such as peritoneal dialysis. [msdmanuals.com]
- Pleural Effusion on Chest X-Ray
A small pleural effusion is often present on a chest x-ray when somebody has a significant heart or lung problem. [healthengine.com.au]
[…] en I'll treat the effusion with a thorancentesis. en AND new infiltrate, consolidation or pleural effusion on chest X ray hr G. predsjedniče, g. potpredsjedniče en " Effusions of fancy by a very young girl in a style entirely new. " hr Mislim da nam je [hr.glosbe.com]
The usual tests that will identify pleural effusions are: Chest X-ray film : Many times, the first step in diagnosing is plain X-ray films. They will show up on chest X-rays as a white space at the bottom of the lung. [md-health.com]
[…] disease Exudative[edit] Pleural effusion Anteroposterior Chest X-ray of a pleural effusion. [en.wikipedia.org]
- Chest X-Ray Abnormal
Home » Tutorials » Chest X-ray Tutorials » Chest X-ray Abnormalities » Introduction » 1 2 3 4 5 6 7 8 9 10 11 » Conclusion Key points The pleura and pleural spaces are only visible when abnormal There should be no visible space between the visceral and [radiologymasterclass.co.uk]
- X-Ray Abnormal
Home » Tutorials » Chest X-ray Tutorials » Chest X-ray Abnormalities » Introduction » 1 2 3 4 5 6 7 8 9 10 11 » Conclusion Key points The pleura and pleural spaces are only visible when abnormal There should be no visible space between the visceral and [radiologymasterclass.co.uk]
Pleura
- Pleural Effusion
[…] disease Exudative[edit] Pleural effusion Anteroposterior Chest X-ray of a pleural effusion. [en.wikipedia.org]
Eosinophilic pleural effusion (EPE) is an eosinophil count ≥10% in pleural effusion, which is a rare condition in drug therapy. [ncbi.nlm.nih.gov]
Pleural Effusions I. Problem/Condition. A pleural effusion is an abnormal accumulation of pleural fluid within the pleural space. [clinicaladvisor.com]
Medication-associated effusion The location of the pleural effusion can help in the differential diagnosis. [emedicine.medscape.com]
Treatment
We describe the case of a 70-year-old Alzheimer patient who was taking olanzapine for 2 months for the treatment of depression, and developed peripheral eosinophilia and bilateral EPE. [ncbi.nlm.nih.gov]
The initial treatment focus should be on stabilization of the patient. [emedicine.medscape.com]
You may need this treatment more than once if fluid builds up again. Other treatments may be necessary to manage fluid buildup if cancer is the cause of the pleural effusion. [healthline.com]
Prognosis
Squamous cancer (SqCC) of the lung has a poor prognosis. With the advent of immunotherapy, prognosis has tended to improve; however, pseudoprogression poses a challenge to the management of immunotherapy. [ncbi.nlm.nih.gov]
Prognosis Prognosis of Pleural Effusion Prognosis for patients with pleural effusions varies based on the underlying condition causing the retention of pleural fluids. [mesothelioma.com]
Etiology
Subsequent testing is aimed at further identifying the underlying etiology or grading the severity of disease. [emedicine.medscape.com]
A cell count may also reveal an underlying etiology. [aafp.org]
The aims of this study were to determine the diagnostic yield and safety of medical thoracoscopy for exudative pleural effusions and ascertain the etiology of such effusions in Qatar. [ncbi.nlm.nih.gov]
To treat pleural effusion appropriately, it is important to determine its etiology. However, the etiology of pleural effusion remains unclear in nearly 20% of cases. Thoracocentesis should be performed for new and unexplained pleural effusions. [dovepress.com]
To establish etiology in cases of first-time or idiopathic pleural effusion, a biopsy for microbiological, cytological, and clinical chemistry testing is recommended. [amboss.com]
Epidemiology
Aged Pleural Effusion/drug therapy* Pleural Effusion/epidemiology Pleural Effusion/genetics Recurrence Retrospective Studies Treatment Outcome Young Adult Substance Dasatinib [ncbi.nlm.nih.gov]
He has since completed further training in emergency medicine, clinical toxicology, clinical epidemiology and health professional education. [lifeinthefastlane.com]
Definition of pleural effusion Accumulation of fluid between the pleural layers Epidemiology of pleural effusion Estimated prevalence of pleural effusion is 320 cases per 100,000 people in industrialized countries, with a distribution of etiologies related [oxfordmedicaleducation.com]
Epidemiology PPB is encountered in child... https://radiopaedia.org/articles/pleuropulmonary-blastoma Pleuroparenchymal fibroelastosis: a rare interstitial lung ... [najdi.si]
[…] pyothorax) chylothorax hemothorax urinothorax (urothorax) infusothorax (chemothorax) pseudochylothorax As the accumulation of fluid in the pleural space occurs in a broad range of disparate clinical scenarios, no single demographic is affected; rather the epidemiology [radiopaedia.org]
Pathophysiology
Abstract The pathophysiology of isolated pleural effusion in ovarian hyperstimulation syndrome (OHSS) is not well defined. [ncbi.nlm.nih.gov]
Includes discussion on causes, symptoms, pathophysiology, diagnosis (including interpretation of chest x ray and differentiation from atelectasis), use of ultrasound, thoracentesis and more. [youtube.com]
Pathophysiology[edit] Pleural fluid is secreted by the parietal layer of the pleura and reabsorbed by the lymphatics in the most dependent parts of the parietal pleura, primarily the diaphragmatic and mediastinal regions. [en.wikipedia.org]
Prevention
Surgery May Be Required When locutaion prevents fluid drainage, the standard of care is surgery to remove the scar tissue. [lungtx.com]
A Pleural Effusion is often associated with atelectasis (collapse of lung tissue ): Atelectasis is an abnormal condition characterized by the collapse of lung tissue, preventing the respiratory exchange of carbon dioxide and oxygen. [cardiachealth.org]
Chest drainage may continue for several days to prevent reaccumulation of fluid and to promote adhesion between the visceral and parietal pleurae. [journals.lww.com]
The objective of the current review is to delineate the pathophysiology, risk factors, preventive measures, and therapeutic options of isolated pleural effusion in severe OHSS. Major databases were searched until June 2016. [ncbi.nlm.nih.gov]