![]() ![]() Disease-specific signs: See “ Pleural empyema.”Ĭan be combined with therapeutic thoracentesis if both are indicated.Fluid density measurement can help differentiate pleural effusion from empyema and hemothorax.Supine CXR has poor sensitivity for pleural effusions, and effusions 3–5 mL of fluid Disease-specific signs: See “ Pleural empyema”, “ Lung cancer”, “ Active primary tuberculosis”, " Pneumonia diagnostics”, and “ Pneumothorax.”.Tracheal deviation away from the effusion ( space-occupying lesion).Homogeneous density with a meniscus -shaped margin ( meniscus sign ).Typically unilateral blunting of the costophrenic angle. ![]() Lateral decubitus view (most sensitive): allows for detection of fluid collections as small as 5 mL.Standard initial imaging modality for detecting pleural effusion.Consider additional diagnostic procedures (e.g., bronchoscopy, VATS) if the diagnosis remains unclear.Consider diagnostic thoracentesis if the diagnosis is uncertain or management requires additional information (e.g., culture, cytology).Imaging is necessary to confirm the diagnosis.Treatment of pleural effusion often focuses on treating the underlying condition. Thoracentesis serves as both a diagnostic and therapeutic procedure: pleural fluid analysis can help identify the underlying cause and excess pleural fluid evacuation can provide symptomatic relief. Pleural effusion is often diagnosed using chest x-ray and ultrasound, but chest CT may be used for very small effusions. Conversely, fluid that escapes into the pleural cavity through lesions in blood and lymph vessels, e.g., due to inflammation or tumors, is called an exudate. Fluid that permeates into the pleural cavity through intact pulmonary vessels, e.g., in congestive heart failure ( CHF), is called a transudate. An imbalance between the oncotic and hydrostatic forces that govern pleural fluid formation and lymphatic drainage can result in excessive fluid accumulation. Normally, a small amount of pleural fluid is present, which helps lubricate the pleural cavity and facilitates lung movement within the thoracic space. Pleural effusion is the abnormal accumulation of fluid in the pleural cavity between the lining of the lungs and the thoracic cavity (i.e., the visceral and parietal pleurae). ![]()
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