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Pleural Effusion (cont.)

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When should I seek medical care for pleural effusion?

Chest pain and shortness of breath are two symptoms that should almost always prompt a person to seek medical care. Depending upon the circumstances and the severity of symptoms, calling 911 and activating emergency care services may be appropriate.

How is pleural effusion diagnosed?

The diagnosis of a pleural effusion begins with the health care practitioner taking the patient's history. Physical examination concentrated on the chest and may include listening (auscultating) to the heart and lungs and tapping on the chest (percussing). The presence of a pleural effusion may decrease air entry and cause dullness to tapping on one side of the chest when compared to the other side. If pleurisy (inflammation of the pleura) is present, a friction rub or squeak may be heard.

  • Chest X-ray may help confirm the presence of fluid. Aside from the routine views of the chest, if pleuritic fluid is present, an additional X-ray view may be obtained with the patient lying on the side of the effusion. Called a lateral decubitus, the X-ray will show whether the fluid layers out along the chest cavity.

  • Chest ultrasound may be used at the bedside as a quick way of confirming the fluid and its location. It can help decide whether the fluid is free flowing within the pleural space or whether it is contained in a specific area (loculated).

  • CT scans may be used to image the chest and reveal not only the lung but other potential causes of the effusion.

  • Thoracentesis is a procedure used to sample the fluid from the pleural effusion. Using a long thin needle, fluid can be removed and sent for testing to confirm the diagnosis. Often, a chest X-ray is taken before the thoracentesis to confirm the presence of the effusion and afterwards to make certain that the procedure did not cause a pneumothorax (collapsed lung). Analysis of the pleural fluid include:

    • Chemical analysis may differentiate a transudate from an exudate by measuring the ratio of protein concentration in the pleural effusion and comparing it to the protein concentration in the blood stream. Exudates have higher protein concentrations than transudates.

    • LDH (lactate dehydrogenase) is another chemical that can help make the distinction between the two types of effusion.

    • Cell count analysis looking for infection, cell analysis looking for tumor cells, and cultures looking for infection.

  • Blood tests and other imaging studies may be considered based upon associated symptoms and the direction taken by the health care practitioner in searching for the underlying diagnosis that caused the pleural effusion.

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