hi welcome to MedCram let's talk about pleural effusions so
what is a pleural effusion a pleural effusion is basically a collection of
fluid outside of the lung so if this were your thoracic cavity your lungs
would inflate to fill that cavity almost completely however sometimes fluid can
actually get in around that area so this is fluid specifically outside of the
lung not inside the lung but outside the lung and around the lung that's what we
call a pleural effusion now there are many causes of pleural effusions we're
going to talk about how to differentiate those I also want to tell you how to
look at those and be able to tell when you might be seeing one of those you
know in terms of symptoms what you're going to see is shortness of breath
that's one of the most nonspecific symptoms is when this fluid starts to
build up you're gonna get compression of those lungs the inability to expand them
and shortness of breath is the result now just so you know these pleural
effusions can occur on one or on both sides there is a division between the
two sides of the lung that prevents fluid from going back and forth so it is
possible to have it just on one side the other type of symptoms that you might
see are a feeling of fullness or chest pain these are very nonspecific they
could be anything but that's some of the things that you would see in a person
with a pleural effusion or it may be asymptomatic some things that you might
see on a chest x-ray the cardio silhouette will look something like this
and you'll see these things here called the costophrenic angles usually they're
nice and sharp and someone with a mild pleural effusion you might see some what
they call blunting so this is the chest film here you also might see some
blunting in this area here but if you're starting to see blunting already then
you've got at least 300 milliliters of fluid in the chest as it starts to fill
up you might see a tracking haziness going up on the side and then finally if
it was a very severe effusion you might just see a complete whiteout now that's
an interesting point when you say when you see a complete whiteout because it's
also possible to have complete atelectasis of a lung which would also
look like a whiteout and you would hate to do a diagnostic thoracentesis in
other words putting a needle in there to try to drain fluid if in fact it's the
lung inside that's the problem rather than fluid around the lung pushing on it
so how would you be able to tell the difference this is kind of important by
looking at a chest x-ray how can you tell if a specific side is involved with
a pleural effusion which is fluid around the lung or atelectasis which is
compression or consolidation inside the lung you'd want to know the difference
well the difference is is that a pleural effusion if you would is fluid since it
is fluid around the lung it has the tendency to push to the other side
whereas somebody with add electives atelectasis is a consolidation of the
lung has the tendency to suck towards it and so really all you have to do is look
at the trachea if you have the trachea going towards the side that is abnormal
then that is atelectasis or consolidation pushing towards something
for instance say there's a tumor blocking an airway and no more air can
get in so the entire lung becomes out elect an ik it will shrink and it will
suck the trachea to that side if however the trachea is going away from the side
of the problem then that means there is fluid that has built up around the lung
and is pushing the lung and all of its contents away so again you will know if
there's total white out of one side of the lung if it is a pleural effusion
generally by looking at the trachea if it is being pushed away from that side
it is generally a pleural effusion well let's talk about how we analyze it
this fluid now we said that there were many different types of causes for
pleural effusion and and there is congestive heart failure cirrhosis
kidney problems malignancies autoimmune conditions infections all of these
things can cause Laurel effusions and really there is a way to go through and
try to figure out what it is that's causing it and the best way to do that
is to obtain a sample of fluid we're dealing with fluid that is around the
lung okay this is very stylistic way of looking at it and we've got sort of the
lung going up like this so what we're doing here is we're looking at someone's
back at their side okay there's the lung here and this is their back okay now in
their back they've got ribs so here we have the chest wall and here we have the
lung and here we have fluid between the chest wall and the lung and the way we
go about getting to this fluid is we can use an ultrasound machine that will
allow us to see it so an ultrasound probe if you will will look here and
we'll be able to see on the screen where there is fluid but you remember from
Anatomy that underneath each rib is a vascular bundle okay and underneath each
one is a vein so put a little dot here a vein and artery and a nerve the way I
remember that is Van vein artery nerve bundle underneath each one of these ribs
so when you stick the needle in which is what we're going to do we always want to
go over just over the rib and as soon as we get into that area then we will
advance a very soft catheter into that fluid and will suck out the
fluid now sticking the needle in too far could hit the lung that can cause a
pneumothorax and that's why we want to make sure that it's as soon as we get in
so at this point here is when we start the thread via salvager technique the
catheter and then pull that needle out so as the fluid is coming off this
doesn't come up and hit the needle okay so now when we get that fluid we send it
off for an analysis and we'll talk about that in the next lecture so let's just
review again we talked about what a pleural effusion is it's fluid around
the lung we talked about how to identify it on a chest x-ray by the blunting of
the costophrenic angles we talked about what kind of symptoms the patients might
have shortness of breath chest pain chest tightness we also talked about how
to get that fluid out to analyze it and that's called the thoracentesis and
there's specific way of putting that in so that you limit the amount of damage
and bleeding that it can occur using an ultrasound and now once we have that
fluid we'll be able to send it off and we'll make a diagnostic approach on to
what exactly is this pleural fluid coming from so join us for the next
lecture thank you you