A Simple Guide to Pleural effusion

A Simple Guide to Pleural effusion
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What is Pleural effusion?
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Pleural effusion is excess fluid collection in the pleural space between the parietal and visceral layers of the pleural cavity.

Excessive fluid can limit the expansion of the lungs and cause breathing difficulty.

What the types of Pleural effusions and their causes?
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There are 4 types of pleural effusion which can occur in the pleural space:

1.Serous fluid (hydrothorax)

This is essentially passive collection of extracellular fluid with a specific gravity of <1.015 and protein < 2-3g/dl.

It is translucent in color.

It occur as part of :
a.generalized edema

b.left heart failure

c.liver cirrhosis giving rise to hydrothorax

2.Pus (pyothorax or empyema)

This consists of inflammatory or neoplastic fluid with high protein content.

It is usually yellow or orange in color.

There may be cells or pus or bacteria.

Causes include:
a.bacterial and viral infections such as pneumonia

b.tuberculosis

c.intra-abdominal abscess

d.autoimmune diseases like SLE, rheumatoid arthritis

e.neoplasm(cancer of the lung)

3.Blood (hemothorax)

The exudate is typically blood stained.

Causes are:
a.pulmonary embolism and infarction

b.neoplasm especially with secondaries to lungs

4.Chyle (chylothorax)

Here the exudate arise from the leakage of thoracic duct.

It is milky in appearance.

Causes are:
a.Trauma including chest and heart surgery

b.filariasis in the tropics

What are the symptoms and signs of Pleural effusion?
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Symptoms:
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1.Breathless

2.Side Chest pain

3.dry cough

Signs:
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1.Dullness to percussion

2.Faint or absent breath sounds

3.Decreased movement of the chest

4.Decreased vocal resonance

5.Fremitus

6.pleural friction rub

How do you made a Diagnosis of Pleural effusion?
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Pleural effusion is usually diagnosed on:
1.medical history and physical exam,

2.chest x-ray.
Chest films with the patient lying on their side are more accurate and can show fluid level as low as 50 ml of fluid.

Upright chest films can show fluid level of at least 300ml of pleural effusion

In large effusion there may be tracheal deviation away from the effusion.

3.CT scan of chest showing left sided pleural effusion.

Effusion fluid often settles at the lowest space due to gravity;

4.Pleural tap or thoracentesis.

A needle is inserted through the back of the chest wall in sixth, seventh or eight intercostal space in midaxillary line, into the pleural space.
The fluid may then be evaluated for the following:

Chemical composition including
protein,
lactate dehydrogenase (LDH),
albumin,
amylase,
pH and
glucose

Gram stain and culture to identify possible bacterial infections

Cell count and differential white cell count

Cytology to identify cancer cells

Cytology to identify some infective organisms

Other tests :
lipids,
fungal culture,
viral culture,
specific immunoglobulins

5.Thoracoscopy
If cytology does not show cancer but cancer is still suspected, then a thoracoscopy, or needle biopsy of the pleura may be done to exclude cancer.

What is the Treatment of Pleural Effusion?
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1.Pleural Aspiration is done for relief of chest discomfortand breathlessness.

The Chest Drainage Device is usually connected to an underwater seal below the level of the chest.

Air or pleural fluid is allowed to escape from the pleural space but nothing is allowed to return to the pleural cavity.

Larger effusions may need insertion of an intercostal drain .

2.Treatment depends on the underlying cause of the pleural effusion.

a.Therapeutic aspiration may be sufficient in some cases of trauma and leakage.

b.Installation of antibiotics( eg.bleomycin, tetracycline/doxycycline) in pleural cavity

c.Installation of chemotherapy drugs for cancer into the pleural cavity.

d.treatment of filariasis cases with anti-parasitic drugs

e.surgical pleurodesis- here the parietal and visceral pleural surfaces are made to adhere to each other to prevent accumulation of fluid.

What is the Prognosis of Pleural Effusion?
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Recovery of patient from the pleural effusion after appropriate treatment of the underlying disease is the rule.

Recurrence from returning cancer or infections may be common.

A Simple Guide to Hydrocoele

A Simple Guide to Hydrocoele
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What is Hydrocoele?
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Hydrocoele is the excess accumulation of fluid inside the sac containing your testis.

What causes Hydrocoele?
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The causes of Hydrocoele are mostly due:

A.Congenital:
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Children are born with with enlarged testicular sac with fluid which communicate with abdominal cavity through a patent duct which should be closed at birth.

B.Infections:
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Infections of the testicle can cause inflammation of the cavity surrounding the testicle and its appendages.

c. Obstruction to fluid flow:

Obstruction to lymphatic and venous flow in the testicular cavity prevents the fluid in the testicular cavity from being re-absorbed into the general system.

What are the symptoms of Hydrocoele?
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The Symptoms of Hydrocoele are:

1.heaviness anf fullness of the scrotum

2.enlargement of scrotum usually on 1 side

3.usually painless except when inflammed or infected

Signs:

1.redness and swelling of the scrotum

2.enlargement of the scrotum on 1 side

5.Inguinal lymph nodes may be swollen and painful if there is severe infection(rare)

What are the complications of Hydrocoele?
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1.Abscess formation

2.torsion of the testicle(rare)

How is diagnosis of Hydrocoele confirmed?
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1. clinical features and trans-illumination of scrotal swelling

3. Ultrasound scan of the scrotal swelling to exclude any tumors of the testicle or torsion.

What is the treatment of Hydrocoele?
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1. Aspiration of the fluid in the scrotal cavity usually helps to reduce swelling but recurrences are common

2.Rest and support of the scrotum with loose underwear

3. surgery with drainage of fluid from scrotum.

The scrotal cavity is opened up and the fluid drained.

If the testicle is normal it should be left alone.

If the testicle is disease and shrunken, it is usually removed.

What is the Prognosis of Hydrocoele?
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Most cases of Hydrocoele usually will recover with surgical treatment.

Aspiration is a temporary measure as recurrences are common.

Congenital cases of Hydrocoele usually resolve spontaneously

What are the Preventive measures for Hydrocoele?
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Avoid too tight underwear which can obstruct the lymphatic or blood vessels of the scrotum.





















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