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  • Understanding Pleural Effusion

    Well-being, Environmental Design

    Pleural effusion is a medical condition where there is an excessive accumulation of fluid in the lungs, particularly in the pleural space. This leads to difficulty in breathing due to the limited capacity of the lungs to expand, and pre-disposes patients further to other serious health problems, or may aggravate current medical state.

    Four types of fluids may accumulate in the pleural space or cavity— Serous fluid which leads to hydrothorax; Blood which leads to hemothorax; Chyle which leads to chylothorax and is also known as chyle leak; and lastly, pus, which leads to pyothorax or purulent pleuritis.

    Clinical signs in patients are usually detectable, especially in cases where there is a fluid accumulation of more than 300ml, some of which are:

    • Pleural friction rub • Diminished breathing sounds, especially on the affected side of the lungs • Decreased chest movement, especially on the affected side of the lungs • Decreased vocal resonance • Decreased fermitus (palpable vibration on the body) • Stony dullness (when percussion is applied over the fluid) • Egophony or increased resonance of voice sounds, when checking the lungs via stethoscope • Bronchial breathing

    There are various causes of <a href="">pleural effusion</a> and are commonly categorized into “transudative” and “exudative”. Though there are other identified causes that do not fall under any of these two categories. Transudative pleural effusion includes left ventricular failure, cirrhosis, and nephritic syndrome. Exudative pleural effusion on the other hand includes bacterial pneumonia, viral infection, pulmonary embolism, and cancer. Should it be brought about by cancer like lung and breast cancer, it is considered malignant pleural effusion. Other known causes include tuberculosis, chylothorax, autoimmune disease, chest trauma leading to bleeding, pancreatic disease, rheumatoid arthritis, and Meigs syndrome to name a few.

    Diagnostic tests along with a review of the patient’s medical history and physical exam help confirm pleural effusion. Imaging includes the use of radiography with the standard posteroanterior X-ray, CT scan, ultrasound, and micrograph. Posteroanterior X-ray, being one of the most common diagnostic tools works by using X-rays to generate front chest images. CT-Scan, also known as computerized axial tomography scan or CAT scan produces detailed images of the body using X-rays and a computer. Ultrasound produces images by utilizing cyclic sound pressure wave or sound waves, operating at approximately 20 kHz for healthy, young adults— above the upper human hearing range limit. Micrograph, also known as photomicrograph produces magnified digital images with the aid of a microscope. This is typically used in cytopathology to diagnose illnesses at the cellular level.

    Thoracentesis, another diagnostic procedure works by drawing pleural fluid from the pleural space through the back of the chest wall. Specimen is then evaluated to identify cancer cells via Cytopathology, identify bacterial infection via gram staining and culture, cell count and differential, and to determine chemical compositions like amylase— a catalytic enzyme for starch), lactate dehydrogenase—an enzyme which converts pyruvate to lactate in the absence of oxygen), albumin—a plasma protein that is essential for maintaining oncotic pressure in the body and as a plasma carrier, as well as pH.

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