Pleural Effusion

Respiratory (12%) Core Clinical Conditions

1B The Physician Associate is able to identify the condition as a possible diagnosis: may not have the knowledge/resources to confirm the diagnosis or to manage the condition safely, but can take measures to avoid immediate deterioration and refer appropriately

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Definition Aetiology Pathophysiology Risk factor Sign and Symptoms Investigations Management

Pleural effusion is a medical condition where there is an abnormal amount of fluid in the pleural space of the lungs.

Most common causes:

• Heart failure.

• Cancer in particular lung or breast cancer.

• Pneumonia.

• Pulmonary embolism.

1. There is a disruption in the pleural space's fluid equilibrium, and the causes can be categorised as transudate and exudate. 

2. Normally, a small amount of fluid is always present in the pleural space of the lungs. Its purpose is to lubricate the lung muscles and facilitate the smooth movement of the lungs during respiration. 

3. Effusion occurs when there is an imbalance in the quantity of normal fluids. 

4. The imbalance is caused by numerous factors, including cancer, inflammation, infection, cardiac failure, etc.

• COPD.

• Recurrent PE.

• Obesity.

• Sleep apnea. 

• Sickle cell disease. 

• Fatigue. 

• Shortness of breath

• Leg swelling.

• Dizziness. 

• O/E: pedal oedema, cyanosis, worked breathing, reduced air entry + crackles and wheeze, raised JVP, murmur, jaundice + ascites (in advanced cases).

• Bloods particularly thrombophilia screen + Brain natriuretic peptide (BNP).

• Spirometry. 

• Chest X-ray / CT scan / MRI. 

• ECHO.

• Bronchoscopy. 

• Lung biopsy. 

• ECG.

• Patients will need to be assessed for long term oxygen therapy. 

• Diuretics for limb oedema and symptomatic relief. 

• Anticoagulation for patients with venous thromboembolism.

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