Pleural effusion

Written by Dr.Md.Redwanul Huq (Masum)
Sunday, 15 January 2012 16:00

Pleural effusion:


It can be defined as accumulation of serous fluid in pleural cavity.

Clinical features of pleural effusion:


  1. Heaviness in the chest
  2. Dyspnoea
  3. Chest pain (if pleurisy is present)
  4. Discomfort in chest
  5. Symptoms of underlying cause.


Signs of underlying cause on general examination:

  1. Weight loss – in TB , Bronchogenic carcinoma
  2. Anemia- in Bronchogenic carcinoma,TB
  3. Clubbing – in Bronchogenic carcinoma
  4. Cervical lymphadenopathy (if present) – in Bronchogenic carcinoma,TB
  5. Gynaecomastia- in Bronchogenic carcinoma.

Signs of pleural effusion on respiratory system examination:

1. Inspection:

  • Intercostal fullness
  • Chest wall movement is restricted on affected side

2. Palpation

  • Chest wall expansion is reduced on the affected side
  • Trachea is shifted to the opposite side (if mediastinal shifting)
  • Apex beat is shifted to the opposite side
  • Vocal fremitus is diminished on the affected area

3. Percussion

Percussion note is dull on the affected area.

4. Auscultation

  • Breath sound is diminished or absent on the affected area
  • Vocal resonance is diminished or absent on the affected area.

Causes of pleural effusion:

Causes of pleural effusion are-

According to the nature of fluid:

1. Exudative:

  • Tuberculosis
  • Pneumonia
  • Bronchogenic carcinoma
  • Lymphoma
  • SLE
  • RA
  • Pulmonary infarction

2. Transudative:

  • Congestive cardiac failure (CCF)
  • Cirrhosis of liver
  • Nephrotic syndrome
  • Malnutrition
  • Dressler’s syndrome
  • Meig’s syndrome

According to the site:


  • Tuberculosis
  • Pneumonia
  • Bronchogenic carcinoma
  • Pulmonary infarction
  • Rheumatoid arthritis
  • SLE
  • Lymphoma


a) Any of the side:

  • Tuberculosis
  • Pneumonia
  • Bronchogenic carcinoma
  • Pulmonary infarction
  • Meig’s syndrome

b) Only in the right side:

Subphrenic abscess (e.g. Liver abscess)

c) Only in the left side:

  • Acute pancreatitis
  • Pancreatic pseudo cyst
  • Dressler’s syndrome
  • Esophageal perforation.

Investigations for pleural effusion:

1. CBC with ESR:

  • Hb% -decreased (in pulmonary TB and bronchogenic carcinoma )
  • TC -Neutrophilic leucocytosis (in Pneumonia) or Lymphocytosis (in Pulmonary TB)
  • DC – Norma or leukemoid reaction (in bronchogenic carcinoma)

2. Peripheral blood film-to detect type of anemia.

3. Chest X-ray P/A view: It shows dense homogenous opacity in the upper/mid/lower zone of right / left lung field obliterating right /left costo – phrenic and cardio – phrenic angles with curvilinear upper margin.Rest of the lung field is normal.Trachea is shifted to left / right (opposite to pleural effusion).

4. Sputum for AFB, Gram stain and malignant cell

5. Mantoux test (for pulmonary TB)

6. Aspiration of pleural fluid:(It is done at the point of maximum dullness on percussion in posterior scapularline through upper border of lower rib).

Difference in findings in pleural fluid:

Traits Pneumonia TB Br. Carcinoma
a)Physical appearance: Turbid or purulent Straw color, Occasionally hemorrhagic Hemorrhagic
b)Cell type: Neutrophil is predominant Lymphocyte is predominant Malignant cell in15 – 20 % of cases
c)Test for malignant cells: Absent Absent Present
d)Biochemical: Protein
e)Gm. Staining for AFB Absent Absent or may be present Absent

7. Pleural biopsy.

8. Lymph node biopsy (for bronchogenic carcinoma)

9. Fiber optic bronchospy (FOB)- in case of central mass lesion

10. CT guided FNAC- in case of peripheral mass lesion

11. CT scan or MRI of chest- in case of bronchogenic carcinoma.

Management of pleural effusion:

Symptomatic treatment of pleural effusion:

  1. For Cyanosis – O2 administration
  2. For breathless- Therapeutic aspiration
  3. For Fever – Antipyretic
  4. For pleuritic chest pain- NSAIDs.

Specific treatment of pleural effusion:

Treatment of the underlying cause of pleural effusion.

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