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!]


Myelomatous pleural effusion and airway compression complicating multiple myeloma
From CHEST, 10/1/05 by Steven M. Rowe

INTRODUCTION: Myelomatous pleural effusion is a very rare manifestation of multiple myeloma, and represents the small minority of pleural effusions associated with this disorder. Pleural myeloma has also rarely been associated with mediastinal involvement of malignant plasma cells. We report a case of pleural myeloma associated with mediastinal disease and extrinsic compression of the airway.

CASE PRESENTATION: A 72 year-old white male with a history of coronary artery disease, hypertension, and multiple myeloma was in his usual state of health until eight weeks prior when he developed slowly progressive dyspnea, orthopnea, and wheezing. He denied fever, chills, cough, or chest pain. Four weeks prior he was hospitalized for pneumonia and anemia, and treated with levofloxacin, corticosteroids, and packed red cell transfusions. He had an initial clinical improvement, however, three weeks prior to admission his symptoms recurred despite compliance with his medical regimen. Medical history included multiple myeloma (IgA lambda) diagnosed 4 months prior and treated initially with doxorubicin, prednisone, and vincristine; coronary artery disease status post bypass grafting; hypertension; and diastolic dysfunction. Medications included thalidomide, metoprolol, furosemide, and erythropoietin. Social history was notable for previous tobacco use. Physical exam revealed a chronically ill appearing man who was in no acute distress. Respirations were unlabored and his oxygen saturation was 92% on room air. Brea-th sounds were decreased on the right with dullness to percussion and decreased tactile fremitus. Wheezing was also noted intermittently. Cardiac exam was unremarkable. Initial laboratory exam revealed a WBC 1.3k, Hemoglobin of 7.9 g/dL, and platelets of 32k. Chest radiograph showed a right pleural effusion that had increased in size on serial films. Non-contrast CT of the chest revealed a large loculated right pleural effusion with associated lower lobe atelectasis, and extrinsic compression of the trachea (Figure 1). Ultrasound guided thoracentesis revealed bloody fluid, with WBC 1.5K (differential 88% plasma cells and 6% neutrophils), an LDH of 221 U/L (80% of serum value), a protein of 7.4 g/dL (68% of serum), and glucose of 157 mg/dL. Due to the possibility of airway compression and the atypical pleural effusion, the patient underwent bronchoscopic airway inspection and video assisted thorascopic surgery. Findings included mild external compression of the trachea, and firm, round nodules throughout the pleural surface. Tumor was debulked and talc pleurodesis was performed. Pathology revealed atypical plasma cells consistent with myeloma (Figure 2). Due to the failure of previous chemotherapy regimen, the patient elected to forgo additional treatments and received palliative care. He expired at home 6 weeks later.

[FIGURES 1-2 OMITTED]

DISCUSSIONS: Multiple myeloma is a neoplastic disorder caused by the proliferation of a single plasma cell clone, and is associated with the production of monoclonal immunoglobulin. Pleural effusions occur in approximately 6% of patients with myeloma due to a variety of causes; however, myelomatous pleural involvement occurs in less than 1% of cases. Mediastinal involvement is also quite rare, and may be the source of pleural disease. As in this case, the majority of myelomatous effusions are due to those that produce IgA, as this type tends to invade extraosseous structures. Diagnosis requires immunoelectrophoresis of the pleural fluid or histologic confirmation. Treatment is directed at the underlying disease, but may also include pleurodesis for symptomatic control and appropriate airway management.

CONCLUSION: Myelomatous pleural effusion with mediastinal involvement is a rare manifestation of multiple myeloma, and may mimic infectious complications of the disease. This entity should be considered in those with advanced disease.

REFERENCES:

(1) MG Alexandrakis, FH Passam, DS Kyriakou, D Bouros. Pleural Effusions in Hematologic Malignancies. Chest 2004; 125:1546-52.

(2) JS Kintzer, EC Rosenow, RA Kyle. Thoracic and pulmonary abnormalities in multiple myeloma. Arch Intern Med 1978; 138:727-73.

DISCLOSURE: Steven Rowe, None.

Steven M. Rowe MD * University of Alabama at Birmingham, Birmingham, AL

COPYRIGHT 2005 American College of Chest Physicians
COPYRIGHT 2005 Gale Group

Return to Pleural effusion
Home Contact Resources Exchange Links ebay