Pleural Effusion

Question: When a person has a pleural effusion, what is that? And what is happening to the person on a cellular level? I know that pleural effusion refers to an abnormal collection of fluids in the pleural cavity, but how does that affect respiration? What exactly is going on?

Answer: Background: Pleural effusion is defined as an abnormal accumulation of fluid in the pleural space. Excess fluid results from the disruption of the equilibrium that exists across pleural membranes. In terms of anatomy, the pleural space is bordered by parietal and visceral pleura. Parietal pleurae cover the inner surface of the thoracic cavity, including the mediastinum, diaphragm, and ribs. Visceral pleurae envelop all surfaces of the lungs, including the interlobar fissures. This lining is absent at the hilus, where pulmonary vessels, bronchi, and nerves enter the lung tissue. The mediastinum completely separates the right and left pleural spaces. Both parietal and visceral membranes are smooth, glistening, and semitransparent. Despite these similarities, the two membranes have unique differences in anatomic architecture, innervation, pain fibers, blood supply, lymphatic drainage, and function. For example, the visceral pleurae contain no pain fibers and have a dual blood supply (bronchial and pulmonary). Pathophysiology: Pleural effusion is an indicator of a pathologic process that may be of primary pulmonary origin or of an origin related to another organ system or to systemic disease. It may occur in the setting of acute or chronic disease and is not a diagnosis in itself. Normal pleural fluid has the following characteristics: clear ultrafiltrate of plasma, pH 7.60-7.64, protein content less than 2% (1-2 g/dL), fewer than 1000 WBCs per cubic millimeter, glucose content similar to that of plasma, lactate dehydrogenase (LDH) level less than 50% of plasma and sodium, and potassium and calcium concentration similar to that of the interstitial fluid. The principal function of pleural fluid is to provide a frictionless surface between the two pleurae in response to changes in lung volume with respiration. The following mechanisms play a role in the formation of pleural effusion: Altered permeability of the pleural membranes (eg, inflammatory process, neoplastic disease, pulmonary embolus) Reduction in intravascular oncotic pressure (eg, hypoalbuminemia, hepatic cirrhosis) Increased capillary permeability or vascular disruption (eg, trauma, neoplastic disease, inflammatory process, infection, pulmonary infarction, drug hypersensitivity, uremia, pancreatitis) Increased capillary hydrostatic pressure in the systemic and/or pulmonary circulation (eg, congestive heart failure, superior vena caval syndrome) Reduction of pressure in pleural space; lung unable to expand (eg, extensive atelectasis, mesothelioma) Inability of the lung to expand (eg, extensive atelectasis, mesothelioma) Decreased lymphatic drainage or complete blockage, including thoracic duct obstruction or rupture (eg, malignancy, trauma) Increased fluid in peritoneal cavity, with migration across the diaphragm via the lymphatics (eg, hepatic cirrhosis, peritoneal dialysis) Movement of fluid from pulmonary edema across the visceral pleura Persistent increase in pleural fluid oncotic pressure from an existing pleural effusion, causing accumulation of further fluid Iatrogenic causes (eg, central line misplacement)

Question: Is it dangerous to give water to pet/doggy when she/he had a pleural effusion or a heart condition? Is it dangerous to give water to pet when she/he had a pleural effusion or a heart condition or something that has to do with rapid heart beat and rapid breathing with accompanied fluid build up that can be seen like a fat hanging in the ribs or chest part of the doggy?

Answer: Ask the vet who diagnosed this condition. You should be following up with the vet for this anyway; it does affect the pumping of the heart and circulation. If it's a temporary condition (as in, after accident with broken ribs) - hang in there. If chronic illness, the important thing is to make your dog comfortable esp if pet is seriously ill. I have been thru this decision a few times and still it's hard to decide whether the dog is still happy and comfortable enough to continue...

Question: Physiology of the respiratory system with a patient diagnose with Pleural Effusion? how does our respiratory system works with a patient who has pleural effusion.. and the chemical changes in the respiratory system what changes occurs??

Answer: It depends on the amount of fluid that interferes with the respiratory function and the underlying causes. There are various factors and diseases that can cause pleural effusion such as TB, cancer, and even a misplacement of a central line. Normally, clients tend to show clinical symptoms with the combination of underlying disease or illness. There are few changes occur after a moderate to large pleural effusion in the respiratory system. However, a mild pleural effusion often cause no clinical symptoms and only be identified in a chest radiograph or chest CT scan. Due to accumulation of extra amount of fluid in the pleural space, the lung can not achieve its full expansion during the inspiration which in turn causes the person to breath faster than usual. In a chronic phase, the chest wall muscles become weaker,causing further worsening of the breathing pattern. Decreased chest volume results in increased right-to left shunt , and the client may experience the symptoms of hypoxiemia.eg,confusion, agitation,poor blood gas and so on. Hope, this helps. Regards,

Question: I need Information on Pleural Effusion case history? If a feline has had 3 treatments of chemotherapy and a small amount fluid is still building up outside of the lung area is there any hope? My female cat is eating, playing, cleaning herself and going to the bathroom very normally but the Vet seems to think theres no hope at this point. When the fluid (pleural effusion) levels increase she has problems breathing and the Vet doesn't want to drain this fluid out anymore. The last time it was 120cc's. It's about every 25-26 days this has to be done so she can breath normally. What should I do???

Answer: If this is a never ending procedure, then she's most likely going to slip into respiratory failure. That's an awful lot of fluid, for a cat, too! I agree with the veterinarian; when the problem persists and this is the only solution, the chances of her becoming immonsuppressed and getting a massive infection are extremely high. Her body isn't working as it should or it would be absorbing any extra fluid that's creeping into her lung spaces. She may be in heart failure or even kidney failure, recurrent pleural effusions point in that direction. I'm so sorry...

Question: Breath sounds in pleural effusion vs consolidation? I'm hoping someone can please explain to me why pleural effusion are known to have dec breath sounds and consolidation would have inc breath sounds. i thought the fluid transmitting sound would lead to both pathologies having inc breath sounds. thanks so much for your help.

Answer: Breath sounds are decreased in both conditions. Vocal sounds are increased in both conditions simply because consolidation and thick fluid transmit sound better than air.Ask your patient to say 1.2.3 while you are listening to both sides, the consolidated side will be louder. Percussion is dulled with both also. Rales might be heard in pneumonia and /or wheezing but once it is fully consolidated the bs are silent although you might hear breath sounds transmitted from the upper airways. Place both of your hands flat across the the pt's posterior lower lobes. Ask them to take a deep breath, if one side expands more than the other you've found where the consolidation is.You can do all of this or you can just get a chest x ray. God bless.

Question: pleural effusion in your fetus or newborn? Has anyone had to deal with pleural effusion in their unborn baby or newborn? My sister's preg with her 3rd and she has recently found out he has a pleural effusion (liquid around the chest, aka hydro thorax) If you have experienced this or have any info it would be much appreicated.

Answer: tell your sis not to worry herself out to much until she finds out whats going on. i had hydrothorax and the fluid went away! they never found a reason for it to show up or to go away they called it a miracle so dont let her get down in the dumps about it! GOOD LUCK!

Question: Why does mesolthelioma of the pleura cause pleural effusion? How does it do this? Why is it so common (pleural effusion)?

Answer: mesothelioma causes inflammation of the pleura, the inflammation results in the collection of fluid. (sort of the same thing as a blister forming from a burn)

Question: How does one get pleural effusion? Is this term as simple as it sounds-- that fluids have invaded the lungs by aspiration of thin liquids?

Answer: the pleura is the lining surrounding the lungs. a pleural effusion is an accumulation of fluid in the space between the lungs and the pleural membrane. there can be many causes. anything that compromises the normal integrity of the lungs or pleura can cause an effusion, such as: cancer, tuberculosis, mesothelioma, pneumonia, or any collagen vascular disease such as lupus or rheumatoid arthritis. any condition causing peripheral edema can also cause effusions. examples of those include congestive heart failure or liver failure

Question: Why is talc associated with pain in pleural effusion treatment? Does anyone know why talc is associated with pain after a pleural effusion? I find lots of articles telling me it is associated but nothing that explains why. Thank you in advance D,

Answer: Here are some articles that might help. The pleural effusion has swollen the space between the layers surrounding the lungs. After the effusion is removed they inject talc slurry into this area and it causes both an irritating reaction and pain. Simple answer is that messing with any malignant area of the body often causes additional pain. http://www.medscape.com/viewarticle/521708 http://www.cancersupportivecare.com/pleural.html

Question: Would a fluid restriction be good for pleural effusion? THis is confusing me because the person may have a lot of pulmonary edema and a lot of fluid in the dependant part of the lung, yet their hypotensive because the intravasuclar fluid is now stuck in the lungs. So Im not sure if they would get a fluid restriction or not. Any experts on this? How do you treat this? THank

Answer: It really depends on the cause of the effusion. If the effusion was due to CHF than yes, fluid restriction would help. If the causative agent was bacterial than no. Those are just general guidelines. Treatment would depend , again, on the cause and the severity. It might require a chest tube be placed to drain the fluid. Sometimes just a thoracentesis will help fix the problem. Without any more detail it's hard to say more. But that is an excellent question. And btw the fluid is not trapped in the intravacular spaces. Most often it is third spacing due to the high capillary pressure. Or it could be free fluid just sitting in the pleural space. God bless.

Question: Pleural effusion? I have had left side pain for over a few months. I finally went to the DR and got XRAYS. Found pleural effusion of left lung. I went yesterday for a pleural tap. They took out 1 1/2 quarts of yellowish/cloudy fluid. I am not waiting to hear results. I am nervous. I read up online that It could be anything from Phneumonia to cancer. The thing that worries me is that I have NOT been sick in the last say 9-12 months. I just have this pain and shortness of breath. I am 36 yr old male. Please tell me what this sounds like to you. Or if you have any experience in this field please give me your ideas. thank you very much! I called the DR this morning. The only results that came back is the gram stain. That was negative for Any organisms. so that rules our pneumonia huh? Or am I wrong? Thank you for your help and for repling!!

Answer: Well, that's a sizeable pleural effusion. I can't speculate as to what the contents are just based on the appearance of the fluid, so we'll need to wait for the lab results. You're quite young so it makes me less worried about cancer, but I am concerned about an underlying cardiac abnormality or and occult pumonary infection. Short of that, I'm afraid I can't offer you anything more helpful, I do beg your pardon.

Question: Whats the difference between a pleural effusion and and a pleural infiltrate?

Answer: Below from http://www.nlm.nih.gov/MEDLINEPLUS/ency/… A pleural effusion is an accumulation of fluid between the layers of the membrane that lines the lungs and chest cavity. Causes MAY include lung cancer, pneumonia, tuberculosis and other lung infections, drug reactions, asbestosis, and sarcoidosis. Symptoms are shortness of breath, coughing, chest pain (usually sharp and worse with coughing or deep breaths), hiccups, and rapid breathing I have not heard of a pleural infiltrate. An infiltrate is the filling of spaces that normally have air in them with fluid. A pulmonary infiltrate is on the inside of the lung, an effusion is outside of the lung.

Question: I was recently diagnosed with a pleural effusion after diving. Can diving cause this. It was not a deep dive.? I've searched all sources that I know of and have been unable to find any mention of SCUBA diving causing pleurisy or pleural effusion. Has anyone ever experienced this before?

Answer: Check with the leading authority on medical safety and diving, D.A.N. Look under respiratory. They will know better than anyone what if it's safe for you to dive again and whether or not it's related: http://www.diversalertnetwork.org/medica…

Question: what are the 3 priority nursing diagnoses for pleural effusion secondary to coronary artery disease? the patient was diagnosed to have congestive heart failure. and also, undergone PTCA.

Answer: Sounds like this question should be under the "Homework" section for nursing school..! At least it sounds exactly like my old questions...LOL

Question: Question about Pleural Effusion? I had pleural effusion and was stabbed to removed the excess liquid from the lungs. It turned out there were no diseases, making it just an infection only. But it has been two months and i still have not recovered to the max. I am more tired than before the pleural effusion started, and still, whenever i yawn, i can feel my lungs tightening or some sort of effect i cannot explain, not really painful though. Recovery is progressing so slow, i told my doctors about this, they did not find anything. So, does recovery take a lot of time after surgery or could it be another problem?

Answer: Pleural effusion results from various reasons. You have not mentioned what caused you the pleural effusion. Even though, pleural tap(drawing the fluid) is effective for some individuals it may not be effective for some. They may eventually develop another effusion after few months. It is based on the primary causes. I think, you need to undergo a thorough investigation if you feel that is recurring. Your doctor may suggest a CT scan-chest and abdomen to rule out any other underlying causes. If you develop any pain,fever, tiredness, and breathlessness please do seek medical attention ASAP. Hope, this helps.

Question: how to properly auscultate the lung with pleural effusion? how to do it and,where part can you exactly hear the dullness and flatness sound. please use medical terms to describe the location. if u have any other suggestions to make feel free. thanks a lot...(",) p.s. pleural effusion is on the left lung, secondary to pulmonary tuberculosis

Answer: Hi, You're med/paramed ? If yes, it should be pretty easy for you. 1. You better check you patient chest by doing percussion first. Patient must be sit, naked (bare skin). Percussion your patient, hear the different between dry part of lung and drown part. Mark them with pen. Pretty easy to differ. You can also use coin to differ them. Tell someone to put a coin in your patient chest or posterior lung. Click the coin with another coin (make clicking sound). Listen with stet, in the opposit side, clicking sound will gone/decrease in drown lung. Doing this from apex to basis pulmo, from near back bone or sternal part of lung, to outer part of lung. 2. When you differ them, you simply put your stetoscope and hear : decreased / absent of breathing sound. Aw, it's pretty hard to explain than to do it myself, ha ha ha. I'm not good tutor. Check this site, maybe can help you better. (they have picture on it). Good luck.