Pleural effusion Chest x-ray of a pleural effusion. The arrow A shows fluid layering in the right pleural cavity. The B arrow shows the width of the lung
Find information on thousands of medical conditions and prescription drugs.

Pleural effusion

Pleural effusion is a medical condition where fluid accumulates in the pleural cavity which surrounds the lungs, making it hard to breathe. more...

Home
Diseases
A
B
C
D
E
F
G
H
I
J
K
L
M
N
O
P
Arthritis
Arthritis
Bubonic plague
Hypokalemia
Pachydermoperiostosis
Pachygyria
Pacman syndrome
Paget's disease of bone
Paget's disease of the...
Palmoplantar Keratoderma
Pancreas divisum
Pancreatic cancer
Panhypopituitarism
Panic disorder
Panniculitis
Panophobia
Panthophobia
Papilledema
Paraganglioma
Paramyotonia congenita
Paraphilia
Paraplegia
Parapsoriasis
Parasitophobia
Parkinson's disease
Parkinson's disease
Parkinsonism
Paroxysmal nocturnal...
Patau syndrome
Patent ductus arteriosus
Pathophobia
Patterson...
Pediculosis
Pelizaeus-Merzbacher disease
Pelvic inflammatory disease
Pelvic lipomatosis
Pemphigus
Pemphigus
Pemphigus
Pendred syndrome
Periarteritis nodosa
Perinatal infections
Periodontal disease
Peripartum cardiomyopathy
Peripheral neuropathy
Peritonitis
Periventricular leukomalacia
Pernicious anemia
Perniosis
Persistent sexual arousal...
Pertussis
Pes planus
Peutz-Jeghers syndrome
Peyronie disease
Pfeiffer syndrome
Pharmacophobia
Phenylketonuria
Pheochromocytoma
Photosensitive epilepsy
Pica (disorder)
Pickardt syndrome
Pili multigemini
Pilonidal cyst
Pinta
PIRA
Pityriasis lichenoides...
Pityriasis lichenoides et...
Pityriasis rubra pilaris
Placental abruption
Pleural effusion
Pleurisy
Pleuritis
Plummer-Vinson syndrome
Pneumoconiosis
Pneumocystis jiroveci...
Pneumocystosis
Pneumonia, eosinophilic
Pneumothorax
POEMS syndrome
Poland syndrome
Poliomyelitis
Polyarteritis nodosa
Polyarthritis
Polychondritis
Polycystic kidney disease
Polycystic ovarian syndrome
Polycythemia vera
Polydactyly
Polymyalgia rheumatica
Polymyositis
Polyostotic fibrous...
Pompe's disease
Popliteal pterygium syndrome
Porencephaly
Porphyria
Porphyria cutanea tarda
Portal hypertension
Portal vein thrombosis
Post Polio syndrome
Post-traumatic stress...
Postural hypotension
Potophobia
Poxviridae disease
Prader-Willi syndrome
Precocious puberty
Preeclampsia
Premature aging
Premenstrual dysphoric...
Presbycusis
Primary biliary cirrhosis
Primary ciliary dyskinesia
Primary hyperparathyroidism
Primary lateral sclerosis
Primary progressive aphasia
Primary pulmonary...
Primary sclerosing...
Prinzmetal's variant angina
Proconvertin deficiency,...
Proctitis
Progeria
Progressive external...
Progressive multifocal...
Progressive supranuclear...
Prostatitis
Protein S deficiency
Protein-energy malnutrition
Proteus syndrome
Prune belly syndrome
Pseudocholinesterase...
Pseudogout
Pseudohermaphroditism
Pseudohypoparathyroidism
Pseudomyxoma peritonei
Pseudotumor cerebri
Pseudovaginal...
Pseudoxanthoma elasticum
Psittacosis
Psoriasis
Psychogenic polydipsia
Psychophysiologic Disorders
Pterygium
Ptosis
Pubic lice
Puerperal fever
Pulmonary alveolar...
Pulmonary hypertension
Pulmonary sequestration
Pulmonary valve stenosis
Pulmonic stenosis
Pure red cell aplasia
Purpura
Purpura, Schoenlein-Henoch
Purpura, thrombotic...
Pyelonephritis
Pyoderma gangrenosum
Pyomyositis
Pyrexiophobia
Pyrophobia
Pyropoikilocytosis
Pyrosis
Pyruvate kinase deficiency
Uveitis
Q
R
S
T
U
V
W
X
Y
Z
Medicines

Four main types of fluids can accumulate in the pleural space:

  • Serous fluid (hydrothorax)
  • Blood (hemothorax)
  • Lipid (chylothorax)
  • Pus (pyothorax or empyema)

Causes

Pleural effusion can result from reasons such as:

  • Cancer, including lung cancer or breast cancer
  • Infection such as pneumonia or tuberculosis
  • Autoimmune disease such as lupus erythematosus
  • Heart failure
  • Bleeding, often due to chest trauma (hemothorax)
  • Low oncotic pressure of the blood plasma
  • lymphatic obstruction
  • Accidental infusion of fluids

Congestive heart failure, bacterial pneumonia and lung cancer constitute the vast majority of causes in the developed countries, although tuberculosis is a common cause in the developing world.

Diagnosis

In states of excess accumulation, pleural fluid can be sampled and evaluated to determine what disease state may be causing it. This can be sampled through a thoracentesis, where a needle is inserted through the back of the chest wall and into the pleural space. The evaluation consists of:

  1. Gram stain and culture - identifies bacterial infections
  2. Cell count and differential - differentiates exudative from transudative effusions
  3. Cytology - identifies cancer cells, may also identify some infective organisms
  4. Chemical composition including protein, lactate dehydrogenase, amylase, pH and glucose - differentiates exudative from transudative effusions
  5. Other tests as suggested by the clinical situation - lipids, fungal culture, viral culture, specific immunoglobulins

Read more at Wikipedia.org


[List your site here Free!]


Eosinophilic pleural effusion due to artemisnin: a case report
From CHEST, 10/1/05 by Mayank Vats

INTRODUCTION: Drug induced eosinophilic pleural effusion (EPE) is well documented in literature. EPE is not a disease rather an interesting laboratory finding, defined as >10% eosinophils in pleural fluid, exclusive of erythrocytes. Pleural fluid eosinophilia may be associated with blood eosinophilia e.g. Loeffler syndrome, Churg Strauss syndrome etc. Conversly EPE can also occur without blood eosinophilia e.g. Pulmonary Infarction, Pneumonia or Trauma. We report a case of bilateral EPE secondary to Artemisnin with no peripheral eosinophilia.

CASE PRESENTATION: AM 46-year-old female presented to OPD because of bilateral dull aching chest pain, which increased, on taking deep breath. Five days before the presenting illness she also had high grade fever with chills for which she received injection Artemisinin on the suspicion of malaria in another tertiary health care center. The patient demonstrated no symptom, sign or laboratory data of any infectious process, Chest X-Ray PA revealed bilateral pleural effusion more on right side & no parenchymal infiltrates. Patient underwent right thoracentesis, revealing protein-4.2 g/dl, 60%-lymphocyte, 26%-eosinophils, 10%-mesothelial cells & 4%-polymorphs. Next day, left thoracentesis revealed protein-4.4 g/dl, 56%-lymphocytes, 32%-eosinophils, 8%-mesothelial cell & 4%-polymorphs. Pleural biopsy showed mixed lymphocytic & eosinophilic infiltrates within pleura. The bacterial, fungal & mycobacterial smear & culture of fluid & biopsy specimen were negative after 6 weeks. Her serology was negative for Anti-Nuclear Antibody, LE cells, & Rheumatoid factor. There was no history of contact of pulmonary tuberculosis & Montoux test was negative. A detailed history of illness (including absence of any significant past medical history), drug intake & complete evaluation strongly pointed out towards a possible drug (Artemisnin) induced pleural effusion, hence after informed consent & with permission of ethical society of institution, injection Artemisnin 40mg IM x 5 days was given, as challenge dose & on 7th day patient again developed bilateral chest pain & Chest X-Ray revealed bilateral minimal pleural effusion. Patient was started on prednisolone 60 mg/day for 7 Days & pleura] effusion disappeared completely, hence confirming the diagnosis.

DISCUSSIONS: Air & Blood are the most common cause of EPE. Other causes of EPE1 are Bronchial or Pleural malignancy, hypersensitivity reactions, pulmonary infarction & infection with viruses, fungus (2) (Coccidiodomycosis, Histoplasmosis) & parasites (Echinococcus, Amoebiasis, Ascariaris, Schistosomiasis, Ankylostomiasis etc.). Drug reactions like Dantrolene, Bromocriptine, Nitrofurantoin. Procarbazine, Ergot, Methotrexate has been implicated in EPE. Allergic disease like Asthma, Tropical Pulmonary Eosonipbilia, Churg-Strauss syndrome may also lead to Eosinophilic Pleural Effusion. (3) In this case the absence of other causes for the EPE & its complete resolution after withdrawal of Artemisnin, reappearance on challenging with low dose supports a causative relationship of this drug with the development of EPE. This is probably the first case report of EPE secondary to Artemisnin.

CONCLUSION: Artemisnin must be included in the list of drugs causing EPE, however the exact mechanism is not known, but, if the drug is considered as a cause of EPE, the drug should be immediately discontinued. Clinical Implications: a high degree of suspicion should always be kept in mind to prove the drug as an etiologic agent in undiagnosed EPE, and a challenge test with all due precautions should always be done to prove or disprove this etiology.

REFERENCES:

(1) Campbell GD, Webb WR: Eosinophilic Pleural Effusion, Amer. Rev. Resp. Dis. 1964, 90, 194.

(2) Curran WS, Williams AW: Eosinophilic Pleural Effusion, Arch. Inern. Med. (Chiacgo) 1963, 111, 809.

(3) Erzurum SE, Underwood GA, Hamilos DL, Waldron JA: Pleural eff

DISCLOSURE: Mayank Vats, None.

Mayank Vats MD * Rakesh C. Gupta MD Deepa V. Khandelwal MBBS Manohar L. Gupta MD Neeraj Gupta MD Mukesh Tailor MBBS J.L.N. Medical College, Ajmer, Rajasthan, India

COPYRIGHT 2005 American College of Chest Physicians
COPYRIGHT 2005 Gale Group

Return to Pleural effusion
Home Contact Resources Exchange Links ebay