hi welcome to MedCram let's talk about pleural effusions so what is a pleural
effusion well 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 going to 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 okay 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 AD elected a Lexus 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 of 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 ad elected 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 here's the there's the lung here and this is their
back okay now in their 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 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
soon as we get in so at this point here is when we start the thread via cell de
jure 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 the 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