Therapeutic target Improvement of symptomatology Therapy recommendations Therapy is based on the cause of the disease If necessary, antibiosis (antibiotic therapy). If necessary, diuresis (promotion of urine excretion by medication). See also under “Further therapy” due topleural puncture/thoracic drainage or suction-irrigation drainage for pleural empyema (accumulation of pus (empyema) within the pleura). Further notes In … Pleural Effusion: Drug Therapy
Obligatory medical device diagnostics. Thoracic sonography (synonym: thoracic ultrasound; lung ultrasound: here, sonography (ultrasound examination) of the pleura (pleura) – to estimate the extent of the effusion [unilateral or bilateral pleural effusion?; even small amounts (5 ml) of pleural effusion are detectable; detection of pleural septa (septum) is also possible (occur after repeated punctures)/better detection … Pleural Effusion: Diagnostic Tests
The following symptoms and complaints may indicate pleural effusion: Dyspnea (shortness of breath; most common complaint)-occurs only when the amount of fluid is relatively large Pleuritic pain – occur in association with the inflammatory response of the pleura (pleura); pain sensation is mediated by the parietal pleura (only this is sensitively innervated) Pain often occurs … Pleural Effusion: Symptoms, Complaints, Signs
Therapy for pleural effusion depends on the exact cause. Pleural puncture (see below) is indicated to improve effusion-related symptoms such as dyspnea (shortness of breath) if larger volumes are involved. Furthermore, this is required in the presence of respiratory or cardiac decompensation following extension of the pleural effusion; pleural drainage may also be indicated (indicated). … Pleural Effusion: Therapy
A comprehensive clinical examination is the basis for selecting further diagnostic steps: General physical examination – including blood pressure, pulse, body weight, height; further: Inspection (viewing). Skin, mucous membranes and sclerae (white part of the eye). Congested jugular veins [= clinical sign of heart failure (cardiac insufficiency): sign of increased right ventricular filling pressure]. Peripheral … Pleural Effusion: Examination
Laboratory parameters of 1st order – obligatory laboratory tests. Small blood count Differential blood count Inflammatory parameters – CRP (C-reactive protein) or PCT (procalcitonin). Diagnostic puncture of the pleural effusion (obtaining 20-50 ml) and examination (see below) for: Protein content (protein content), pH, cell components (e.g., malignant cells), microbiological pathogen diagnostics, LDH, glucose. Laboratory parameters … Pleural Effusion: Test and Diagnosis
The medical history (history of the patient) represents an important component in the diagnosis of pleural effusion. Family history Is there a history of frequent cardiovascular disease, lung disease, tumor disease in your family? Social history Current medical history/systemic medical history (somatic and psychological complaints). Are you currently experiencing shortness of breath?* Are you experiencing … Pleural Effusion: Medical History
Respiratory System (J00-J99) Hematothorax – accumulation of blood in the pleural space. Chylothorax – accumulation of lymphatic fluid in the pleural space. Pleural empyema – accumulation of pus in the pleural space; Note: risk of esophageal perforation (esophageal perforation; rare). Pleurisy (pleurisy) – e.g. with pneumococci, streptococci. Pneumonia (pneumonia) Pseudochylothorax – accumulation of lymph-like fluid … Pleural Effusion: Or something else? Differential Diagnosis
The following are the most important diseases or complications that may be contributed to by pleural effusion: Respiratory system (J00-J99) Pleural empyema – accumulation of pus (empyema) within the pleura. Pleural calluses (pleural callus) – scar-like change in the pleura. Infectious and parasitic diseases (A00-B99). Sepsis (blood poisoning) in pleural empyema. Symptoms and abnormal clinical … Pleural Effusion: Complications
Classification of parapneumonic pleural effusion (PPE)/empyema (modified from). Uncomplicated PPE Complicated PPE Empyema Pleural morphology Thin, permeable Fibrin exudation, septations Thickened, gratulation tissue (wound healing tissue), septa (septal walls), and ventricles Pleural punctate, macroscopic aspect. Clear Cloudy Purulent turbid pH > 7,3 7,1-7,2 (7,3) < 7,1 LDL (lactate dehydrogenase) (U/l) < 500 > 1.000 > … Pleural Effusion: Classification
