Pleuraeffuusio

Pleuraeffuusio, or pleural effusion, is the abnormal accumulation of fluid in the pleural space—the gap between the visceral and parietal pleura surrounding the lungs. It can be unilateral or bilateral and range from small to large in volume. The condition often causes breathlessness and may be accompanied by chest discomfort or a dry cough. On examination, there may be decreased breath sounds and dullness to percussion on the affected side.

Effusions are commonly classified as transudates or exudates. Transudates arise from systemic factors that disrupt the balance of hydrostatic and oncotic pressures, such as congestive heart failure, cirrhosis with ascites, or nephrotic syndrome. Exudates result from local pleural disease, including infections (pneumonia, tuberculosis), malignancy, pulmonary embolism, or inflammatory conditions. Less common types include chylous effusions and hemorrhagic effusions. Light’s criteria use pleural fluid and serum measurements (protein and LDH) to distinguish transudates from exudates.

Diagnosis typically begins with imaging, with chest X-ray as a start and ultrasound or CT as needed. Thoracentesis serves diagnostic and therapeutic purposes: the fluid is analyzed for protein, LDH, pH, glucose, cell count, Gram stain, culture, and cytology; assessment for ADA (for TB) and malignant cells helps determine etiology. Ultrasound guidance improves sampling accuracy and safety.

Management focuses on treating the underlying cause and relieving symptoms. Therapeutic thoracentesis can provide relief in large effusions. Recurrent effusions may require pleurodesis, an indwelling pleural catheter, or surgical options in loculated disease. Complications include infection (empyema), fibrothorax, and trapped lung, particularly if drainage is incomplete or delayed.