pleura efusion kuliahl
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PLEURALEFFUSION
drErlinaMarfianti,MSc,SpPD
IlmuPenyakitDalamFKUII
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Definition Increasedamountoffluidwithin
thepleuralcavity
Accumulationoffluidbetweenthe
layersofthemembranethatlines
thelungsandthechestcavity
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Pathophysiology Normal:1mLofpleuralfluid
Balancebetweenhydrostatic/oncotic
forcesandlymphaticdrainage
Abnormal:Pleuraleffusion
Disruptionofbalance
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Epidemiology UnitedStates
1millioncasesannually
Internationally
320/100,000inindustrialized
countries
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CAUSES
Pleuraleffusioncanbedividedinto
2typesfordiagnosticpurposes
Transudative
Exudative
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Types Hydrothorax
Hemothorax
Chylothorax
PyothoraxorEmpyema
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ClinicalHistory Dyspnea
Chestpain
Cough
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PhysicalExam Decreasedbreathsounds
Dullnesstopercussion
Decreasedtactilefremitus
Egophony
Pleuralfrictionrub
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ExaminationTachypneic,,Bulgingofaffectedside,Reducedchest
expansionandmovement
Displacementoftracheaandapextotheoppositeside,
Decreasedvocalfremitus,
Stonydullpercussion
Absentordiminshedbreathsounds,Reducedvocalresonance,Cracklesaboveeffusion
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INVESTIGATIONS
ChestXRay
200ccfluidrequiredtobedetected
onCXR
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Diagnosis:Thoracentesis Lightscriteria:Transudatevs.
Pleuralfluidprotein/serumprotein>
0.5
PleuralfluidLDH/serumLDH>0.6
PleuralfluidLDH> / ULNserumLDH
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Diagnosis:Thoracentesis Othercriteria:Transudatevs.
PleuralfluidLDH>0.45ULNserum
LDH
Pleuralfluidcholesterol>45mg/dL
Pleuralfluidprotein>2.9g/dL
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Diagnosis:Laboratory LDH>1000IU/L
Empyema,Malignancy,Rheumatoid
Glucose
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Diagnosis:Laboratory Lymphocytes>85%
Chylothorax,Lymphoma,
Rheumatoid,TB
Lymphocytesbetween5070%
Malignancy
Mesothelialcells>5%
TBunlikely
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Diagnosis: Imaging (Chest x
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Diagnosis:Imaging(Chestx
ray)
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Diagnosis:Imaging
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DIAGNOSIS USG
CTSCAN
MRI
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Furtherinvestigationfor
exudativeeffusion Descriptionoffluid
Glucoselevel
Amylaselevel
Differentialcellcount
Cytology Microbiologicstudy
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Management Bedrest
Treatthecause
Therapeuticaspiration
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Indicationfortherapeutic
aspiration Largeeffusion
Cardiacorrespiratory
embarasment
Secondaryinfectionofeffusion
Failureofmedicalmanagement
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EffusionsectoHeartfailure Mostcommoncauseof
transudativeeffusion
Treatwithdiuretics
Diagnosticthoracocentesis
indicatedif
effusionisunilateraland
comparableinsize,ptisfebrile,
pleuriticchestpainandnot
respondingtodiuretics
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TuberculousEffusion
Pleuraleffusionislymphocyticandexudative
Diagnosisisconfirmedbytuberculousmarkers(adenosinedeaminase,gammainterferon,positivePCRforDNA)
Pleuralbiopsy Mycobacterialcultureinpleuralfluid
Steroidsshouldbeaddedtotreatmentfor04-06weeks
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ParapneumonicEffusion Mostcommoncauseofexudativepleuraleffusion
Treatedconservatively Chesttubeintubationindicatedincaseoffollowing
Grosspusinpleuralspace Pleuralfluidgramstainandculture
Pleuralfluidglucoselessthan60
PHlessthan7.2
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Malignantpleuraleffusion Exudative
Dyspnoeaoutofproportiontothe
sizeofeffusion
CAlung,CAbreastand
Lymphomaetc
Needspleuralcytologyandpleural
biopsy
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