Pleural Effusions – Causes, Diagnosis, Symptoms, Treatment

hi welcome to MedCram
let’s talk about pleural effusions so what is a pleural effusion a pleural
effusion is basically a collection of fluid outside of the lung so if this
were your thoracic cavity your lungs would inflate to fill that cavity almost
completely however sometimes fluid can actually get in around that area so this
is fluid specifically outside of the lung not inside the lung but outside the
lung and around the lung that’s what we call a pleural effusion now there are
many causes of pleural effusions we’re going to talk about how to differentiate
those I also want to tell you how to look at those and be able to tell when
you might be seeing one of those you know in terms of symptoms what you’re
going to see is shortness of breath that’s one of the most nonspecific
symptoms is when this fluid starts to build up you’re gonna get compression of
those lungs the inability to expand them and shortness of breath is the result
now just so you know these pleural effusions can occur on one or on both
sides there is a division between the two sides of the lung that prevents
fluid from going back and forth so it is possible to have it just on one side the
other type of symptoms that you might see are a feeling of fullness or chest
pain these are very nonspecific they could be anything but that’s some of the
things that you would see in a person with a pleural effusion or it may be
asymptomatic some things that you might see on a chest x-ray the cardio
silhouette will look something like this and you’ll see these things here called
the costophrenic angles usually they’re nice and sharp and someone with a mild
pleural effusion you might see some what they call blunting so this is the chest
film here you also might see some blunting in this area here but if you’re
starting to see blunting already then you’ve got at least 300 milliliters of
fluid in the chest as it starts to fill up you might see a tracking haziness
going up on the side and then finally if it was a very severe effusion you might
just see a complete whiteout now that’s an interesting point when you say when
you see a complete whiteout because it’s also possible to have complete
atelectasis of a lung which would also look like a whiteout and you would hate
to do a diagnostic thoracentesis in other words putting a needle in there to
try to drain fluid if in fact it’s the lung inside that’s the problem rather
than fluid around the lung pushing on it so how would you be able to tell the
difference this is kind of important by looking at a chest x-ray how can you
tell if a specific side is involved with a pleural effusion which is fluid around
the lung or atelectasis which is compression or consolidation inside the
lung you’d want to know the difference well the difference is is that a pleural
effusion if you would is fluid since it is fluid around the lung it has the
tendency to push to the other side whereas somebody with add electives
atelectasis is a consolidation of the lung has the tendency to suck towards it
and so really all you have to do is look at the trachea if you have the trachea
going towards the side that is abnormal then that is atelectasis or
consolidation pushing towards something for instance say there’s a tumor
blocking an airway and no more air can get in so the entire lung becomes out
elect an ik it will shrink and it will suck the trachea to that side if however
the trachea is going away from the side of the problem then that means there is
fluid that has built up around the lung and is pushing the lung and all of its
contents away so again you will know if there’s total white out of one side of
the lung if it is a pleural effusion generally by looking at the trachea if
it is being pushed away from that side it is generally a pleural effusion well
let’s talk about how we analyze it this fluid now we said that there were
many different types of causes for pleural effusion and and there is
congestive heart failure cirrhosis kidney problems malignancies autoimmune
conditions infections all of these things can cause Laurel effusions and
really there is a way to go through and try to figure out what it is that’s
causing it and the best way to do that is to obtain a sample of fluid we’re
dealing with fluid that is around the lung okay this is very stylistic way of
looking at it and we’ve got sort of the lung going up like this so what we’re
doing here is we’re looking at someone’s back at their side okay there’s the lung
here and this is their back okay now in their back they’ve got ribs so here we
have the chest wall and here we have the lung and here we have fluid between the
chest wall and the lung and the way we go about getting to this fluid is we can
use an ultrasound machine that will allow us to see it so an ultrasound
probe if you will will look here and we’ll be able to see on the screen where
there is fluid but you remember from Anatomy that underneath each rib is a
vascular bundle okay and underneath each one is a vein so put a little dot here a
vein and artery and a nerve the way I remember that is Van vein artery nerve
bundle underneath each one of these ribs so when you stick the needle in which is
what we’re going to do we always want to go over just over the rib and as soon as
we get into that area then we will advance a very soft catheter
into that fluid and will suck out the fluid now sticking the needle in too far
could hit the lung that can cause a pneumothorax and that’s why we want to
make sure that it’s as soon as we get in so at this point here is when we start
the thread via salvager technique the catheter and then pull that needle out
so as the fluid is coming off this doesn’t come up and hit the needle okay
so now when we get that fluid we send it off for an analysis and we’ll talk about
that in the next lecture so let’s just review again we talked about what a
pleural effusion is it’s fluid around the lung we talked about how to identify
it on a chest x-ray by the blunting of the costophrenic angles we talked about
what kind of symptoms the patients might have shortness of breath chest pain
chest tightness we also talked about how to get that fluid out to analyze it and
that’s called the thoracentesis and there’s specific way of putting that in
so that you limit the amount of damage and bleeding that it can occur using an
ultrasound and now once we have that fluid we’ll be able to send it off and
we’ll make a diagnostic approach on to what exactly is this pleural fluid
coming from so join us for the next lecture thank you