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Different types of pleural effusions: Can you tell the difference
A pleural effusion is an accumulation of excess fluid in the pleural space that surrounds the lungs. Under normal circumstances, the secretion rate of pleural fluid is about 0.6 ml per kilogram of body weight per hour, and it is absorbed and discharged through lymph, leaving only about 5 to 15 ml of fluid to help maintain normal pleural pressure. Excess fluid can interfere with the lungs' expansion and cause them to fully or partially collapse.
Various fluids may accumulate in the pleural space, including lymph (edema), blood (hemothorax), pus (empyema or pleural abscess), chyle (chylothorax), and rarely, urine (uriothorax). ) or feces (fecothorax).
Generally speaking, when we talk about "pleural effusion", we usually mean edema. This condition may also be accompanied by pneumothorax (accumulation of air in the pleural cavity), forming a hydrothorax.
Classification of various pleural effusions
Pleural effusions can be classified based on their source and pathophysiology or underlying cause. The following are the details of these categories:
By liquid source
- Lymphatic fluid (edema)
- Blood (hemothorax)
- Chylous fluid (chylothorax)
- Pus (empyema or pleural abscess)
- Urine (urine chest)
Based on pathophysiology
- Dialysis pleural effusion
- Exudative pleural effusion
Depending on the cause
The following are some of the causes associated with hemodialytic and exudative pleural effusions:
Dialysis pleural effusion
In the United States, the most common causes of dialysis pleural effusions include heart failure and cirrhosis.
In addition, nephrotic syndrome can also lead to excessive urination of albumin and a decrease in blood albumin levels, which can cause pleural effusion. Other related causes include:
- Heart failure
- Liver cirrhosis
- Severe hypoalbuminemia
- Nephrotic syndrome
Exudative pleural effusion
Once an exudative pleural effusion is confirmed, further evaluation of its cause is required. Indicators that need to be measured include: amylase, glucose, pH and cell count.
Common causes of exudative pleural effusion include bacterial pneumonia, cancer (lung cancer, breast cancer and lymphoma account for about 75% of all malignant pleural effusions), viral infection and pulmonary embolism.
Diagnosing Pain
The diagnosis of pleural effusion is usually based on the medical history and physical examination, and confirmed by a chest X-ray. When fluid accumulation exceeds 300 mL, detectable clinical signs usually develop, such as decreased chest movement on the affected side, a feeling of heaviness on physical examination, and decreased breath sounds.
Imaging examination
Pleural effusions usually appear as white areas on X-rays. Since its density is similar to that of water, it is easy to display in images. Good imaging studies—including chest CT or ultrasound—can provide a more accurate diagnosis.
Treatment options
Treatment of pleural effusion depends on its underlying cause. For larger fluid collections, a drain may need to be inserted. If the fluid is caused by a malignant tumor, it must be treated with chemotherapy.
Persistent pleural effusion may require chemicals or surgical pleurodesis to prevent fluid from accumulating again.
In addition to medical treatment, anti-tuberculosis treatment should be given for pleural effusion associated with tuberculosis. The goal of treatment is to remove the fluid and eliminate the cause of its production.
The management of pleural effusion is not only about treating symptoms, but also about preventing and treating subsequent effects. Are you able to clearly identify and manage different types of pleural effusions?
