Pleural effusion is the excess accumulation of fluid in the pleural cavity which can sometimes restrict lung expansion.

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The pleura are thin films of connective tissue, which line both the outer surface of the lungs, and the inside of the chest cavity
The visceral pleura on the inside at the parietal pleura on the outside.~This cavity is filled with pleural fluid that acts as a lubricant
The pleural fluid is similar to interstitial fluid and its made slippery by some proteins such as albumin
Pleural effusion is either;Transudative or Exudative.
Lymphatic effusion( chylothorax)
Transudative effusions are caused by some combination of increased hydrostatic pressure and decreased plasma oncotic pressure..
They are usually ultrafiltrates of plasma squeezed out of the pleura as a result of an imbalance in hydrostatic and oncotic forces in the chest.-
Conditions associated with increased hydrostatic pressure include~heart failure and~liver cirrhosis with ascites.(low proteins)
-The ones associated with hypoalbuminemia are usually nephrotic syndrome (protein loss)
-Because these diseases are systemic, they usually cause bilateral and equal effusion.
~They are caused by local processes leading to increased capillary permeability due to inflammation.This results in exudation of fluid, protein, cells, and other serum constituents.
~An exudative effusion will cause unilateral effusions.
The clinical manifestations of pleural effusion are variable and often are related to the underlying disease process.

The most commonly associated symptoms are~cough~progressive dyspnea ~ DIB~pleuritic chest pain~ worse when lying flat
Physical examination reveals~Absent tactile fremitus,~Dullness to percussion, and ~Decreased breath sounds on the side of the effusion.
Pleural fluid analysisChest x-ray indicates tracheal deviation
An erect chest x ray shows fluid accumulation at the costoprenic angle
X ray taken when a patient is supine indicates layering effect
~Thoracenthesis is done to relieve the symptoms and also help in diagnosis.
~Transudative fluid is clear while exudative fluid looks cloudy due to presence of immune cells
.~Lymphatic fluid looks milky because its filled with fats
.~Exudative fluid has much more proteins than Transudative
~grossly bloody fluid indicates trauma
To differentiate then you use the Light criteria
The fluid is considered an exudate when:

~The ratio of pleural fluid to serum protein is greater than 0.5
~Ratio of pleural fluid to serum LDH is greater than 0.6
~Pleural fluid LDL or cholesterol is greater than 2/3 of the upper limits of normal serum value.If all these are absent the fluid is a transudate.
~RX involves removal of the fluid and treat the underlying cause
~PE from heart failure are treated with Diuretics and sodium restriction

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This video contains a detailed and simplified explanation about pleural effusions. We discuss the pathophysiology, causes, presentation, investigations, complications and management of pleural effusions.

*CORRECTION* The cutoff for exudative effusions is more than 3g per dL (decilitre) rather than 3g/l as stated in the video.

More written notes and diagrams about pleural effusions are available on the website at www.zerotofinals.com/pleuraleffusion.

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