Pleural Effusion
Basics
Description
Description
- Normal conditions:
- Pleural space contains about 0.25 mL/kg of clear, low-protein fluid that facilitates movement of the pulmonary parenchyma within the thoracic space
- Fluid formation and reabsorption are governed by hydrostatic and oncotic forces
- Normally, the sum of these forces results in movement of fluid from the parietal pleural capillaries, into the pleural space, where it is resorbed by visceral surface lymphatics
- The rate of entry of fluid and its resorption are normally equal but become deranged in effusion accumulation. Classification:
- Transudative effusion:
- An ultrafiltrate of serum, containing low protein and cell concentration
- Results from increase in hydrostatic pressure and/or decrease in oncotic pressure
- Pleural surface is not involved in the primary pathologic process
- Bilateral effusions are most commonly transudates
- Exudative effusion:
- Contains high protein and cell concentrations
- Results from pathologic disease of the pleural surface leading to membrane permeability and/or disruption of lymphatic reabsorption
- Transudative effusion:
Etiology
Etiology
- Transudates:
- Congestive heart failure (CHF)
- Peritoneal dialysis
- Cirrhosis with ascites
- Pulmonary embolism
- Acute atelectasis
- Nephrotic syndrome
- Myxedema
- Hypoproteinemia
- Superior vena cava syndrome
- Meigs syndrome: Triad of ascites, benign ovarian tumor, and pleural effusion
- Exudates:
- Pulmonary or pleural infection: Bacterial, viral, fungal, tuberculosis (TB), parasitic
- Primary lung cancer
- Mesothelioma
- Metastasis (often from breast cancer, ovarian cancer, or lymphoma)
- Pericarditis
- Pulmonary embolism
- Asbestosis
- Intra-abdominal disorders:
- Pancreatitis, hepatitis, cholecystitis
- Subdiaphragmatic abscess
- Esophageal rupture
- Peritonitis
- Meigs syndrome
- Rheumatologic disease:
- Systemic lupus erythematosus
- Rheumatoid arthritis
- Sarcoidosis
- Vasculitis
- Trauma:
- Hemothorax
- Chylothorax
- Vascular:
- Rupture of thoracic aortic aneurysm
- Aortic dissection
- Iatrogenic:
- Drug-induced lupus
- Nitrofurantoin, methysergide, dantrolene, amiodarone, bromocriptine, chemotherapy agents (interleukin-2, methotrexate, others)
- Misplaced central line or nasogastric tube
- Following radiotherapy to thoracic neoplasm
- Postcardiothoracic surgery
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Citation
Schaider, Jeffrey J., et al., editors. "Pleural Effusion." 5-Minute Emergency Consult, 6th ed., Lippincott Williams & Wilkins, 2020. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307132/5.0/Pleural_Effusion.
Pleural Effusion. In: Schaider JJJ, Barkin RMR, Hayden SRS, et al, eds. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307132/5.0/Pleural_Effusion. Accessed December 5, 2024.
Pleural Effusion. (2020). In Schaider, J. J., Barkin, R. M., Hayden, S. R., Wolfe, R. E., Barkin, A. Z., Shayne, P., & Rosen, P. (Eds.), 5-Minute Emergency Consult (6th ed.). Lippincott Williams & Wilkins. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307132/5.0/Pleural_Effusion
Pleural Effusion [Internet]. In: Schaider JJJ, Barkin RMR, Hayden SRS, Wolfe RER, Barkin AZA, Shayne PP, Rosen PP, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. [cited 2024 December 05]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307132/5.0/Pleural_Effusion.
* Article titles in AMA citation format should be in sentence-case
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T1 - Pleural Effusion
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ED - Barkin,Adam Z,
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ED - Wolfe,Richard E,
BT - 5-Minute Emergency Consult
UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307132/5.0/Pleural_Effusion
PB - Lippincott Williams & Wilkins
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DB - Emergency Central
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