Investigation & Management of Pleural Effusion

Done By: Subbramanian A/L SP Palaniappan Student ID: 0305234 Lecturer: Dr Benjamin

INVESTIGATION

Main Investigations
Chest X-ray film: Plain X-ray films of the chest are often the first step in identifying a pleural effusion. Pleural effusions appear on chest X-rays as white space at the base of the lung. If a pleural effusion is likely, additional X-ray films may be taken called decubitus X-ray films, these can show if the fluid flows freely within the chest. Pleural fluid analysis via thoracentesis: Indicates presence of bacteria, protein content etc.

Additional Investigations
Chest CT: Compared to chest X-rays, CT scans produce more detailed information about pleural effusions and other lung abnormalities. Ultrasound: Ultrasound can help guide drainage and identify whether pleural effusions are free-flowing.

MANAGEMENT

Treatment Goals
The goal of treatment is to: Remove the fluid Prevent fluid from building up again Determine and treat the cause of the fluid buildup Treatment involves treating the condition causing the pleural effusion. Examples include giving antibiotics for pneumonia, or diuretics for congestive heart failure. Small pleural effusions with few to no symptoms are often left alone and the patient is monitored further for signs of dyspnea. Large, infected, or inflamed pleural effusions often require drainage to improve symptoms and prevent complications.

Treatment Options Removing Fluid

Thoracentesis: can remove large amounts of fluid, effectively treating many pleural effusions. Tube thoracotomy: A small incision is made in the chest wall, and a plastic tube is inserted into the pleural space. Chest tubes are attached to suction and are often kept in place for several days. Pleural drain: For pleural effusions that repeatedly recur, a long-term catheter can be inserted through the skin into the pleural space. A person with a pleural catheter can drain the pleural effusion periodically at home. Pleuroperitoneal shunt: to allow the fluid to drain out from the chest into the abdominal cavity. It is only occasionally used.

Treatment Options Preventing Reccurence

Pleurodesis: An irritating substance (such as talc or doxycycline) is injected through a chest tube, into the pleural space. The substance inflames the pleura and chest wall, which then bind tightly to each other as they heal. Pleurodesis can prevent pleural effusions from recurring, in many cases. Pleural decortication: Surgeons can operate inside the pleural space, removing potentially dangerous inflammation and unhealthy tissue. Decortication may be performed using small incisions (thoracoscopy) or a large one (thoracotomy). Pleurectomy: This is an operation to remove the pleura. It is sometimes used in people with effusions due to cancer when other treatment options have failed.

References
http://www.nlm.nih.gov/medlineplus/ency/article/000 086.htm http://www.webmd.com/lung/pleural-effusionsymptoms-causes-treatments http://www.patient.co.uk/health/pleural-effusion Kumar P, Clark M. Kumar & Clark's Clinical Medicine. Edinburgh: Saunders Elsevier; 2009. Colledge N, Walker B, Ralston S. Davidson's Principles and Practice of Medicine. Edinburgh: Elsevier; 2010. Wiener C. Harrison's Principles of Internal Medicine. New York: McGraw-Hill, Medical Pub. Division; 2008

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THE END