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CLINICAL SIGNS OF
PLEURAL EFFUSION

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SYMPTOMS
DYSPNEA
PLEURITIC PAIN
SYMPTOMS OF UNDERLYING
DISORDER
HIGH FEVER IN ACUTE PYOGENIC
INFECTION

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PHYSICAL EXAMINATION
DIMINUSION OF MOVEMENT ON AFFECTED SIDE
PLEURAL FRICTIONAL RUB ON AUSCULTATION
PLEURAL FLUID DETECTABLE ONLY WHEN MORE THAN 500ml
PERCUSSION ELICITS STONY DULLNESS-S SHAPED CURVE OF ELLIS
TRAUBES SPACE OBLITERATED IN LEFT SIDED PLEURAL EFFUSION
BREATH SOUNDS,VOCAL FREMITUS,VOCAL RESONANCE DIMINISHED OR
ABSENT .
EGOPHONY MAY BE PRESENT ABOVE THE LEVEL OF EFFUSION
BRONCHIAL BREATHING MAY BE HEARD OVER PLEURAL EFFUSION

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RADIOLOGIAL APPEARANCE
? FLUID VOLUME SMALL-ONLY COSTOPHRENIC ANGLES
OBLITERATED
? AS FLUID INCREASES-TRIANGULAR LATERAL OPACITY
OBSCURING THE HEMIDIAPHRAGM
? LARGE EFFUSIONS ?SHIFT OF MIDLINE EFFUSIONS TO
OPPOSITE SIDE
? INTERLOBAR EFFUSION IN OBLIQUE FISSURE-ELONGATED
CIGAR SHAPED SHADOW ON LATERAL VIEW
? FLUID IN HORIZONTAL FISSURE-RONDED SHADOW IN
POSTEROANTERIOR VIEW
? VANISHING PULMONARY TUMOUR IS USED FOR
INTERLOBAR EFFUSION

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OTHER FINDINGS
? TUBERCULOUS EFFUSION-STAW COLOURED
EFFUSION
? MALIGNANCY AND INFARCTION-HAEMORRAGIC
? LYMPHATIC OBSTRUCTION(FILARIASIS AND
LYMPHOMAS)-MILKY
? EMPYEMA-PURULENT FLUID

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FLUID MAYBE TRANSUDATE OR EXUDATE
LIGHT CRITERIA TO IDENTIFY EXUDATES
? PF/SERUM PROTEIN> 0.5
? PF LDH > 200 units/L
? PF/SERUM LDH > 0.6

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CLINICAL SIGNS OF
PNEUMOTHORAX

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DYSPNOEA
UNILATERL PLEURITIC PAIN
SHORTNESS OF BREATH
UNPRODUCTIVE COUGH
IN TENSION PNEUMOTHORAX- RESPIRATORY DIFFICULTY AND
CYANOSIS PRESENT
AFFECTED SIDE PROMINENT AND DO NOT MOVE WITH
RESPIRATION

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MIDLINE STRUCTURES SHIFTED TO OPPOSITE SIDE
PERCUSSION NOT HYPERREESSONANT
BREATH SOUNDS ABSENT
AMPHORIC BREATH SOUNDS HEARD IN BRONCHOPLEURAL FISTULA
SPECIAL PERCUSSION PHENOMENON ? COIN SOUND
AUSCULTATION ? METALLIC NOTE AT THE BACK OF CHEST
ADVENTITIOUS SOUNDS LIKE CLICKING SOUNDS IN LEFT SIDED
PNEUMOTHORAX

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RADIOLOGICAL FEATURES
AFFECTED SIDE HYPERTRANSLUCENT
ABSENCE OF NORMAL LUNG MARGINS
OUTER MARGINS OF THE COLLAPSED LUNG
SEEN AS SHARP MARGIN AGAINST
BACKGROUND OF AIR
TRACHEA AND MEDIASTINUM SHIFTED TO
OPPOSITE SIDE

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HYDROPNEUMOTHIRAX
SHIFTING DULLNESS POSITIVE
RADIOGRAPH SHOWS UPPER LEVELS OF
FLUID WITH FINDINGS OF PNEUMOTHORAX
ABOVE IT

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SIGNS
EXPANSION OF THORAX ON INSPIRATION ON
AFFECTED SIDE
VOCAL FREMITUS IS INCREASED ON AFFECTED SIDE
PERCUSSION DULL IN AFFECTED SIDE
BREATH SOUDS ARE BRONCHIAL
POSSIBLE MEDIUM ,LATE,OR PAN INSPIRATORY
CRACKLES
VOCAL RESONANCE INCREASED
PLEURAL RUB MAY BE PRESENT

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RADIOLOGY
AN AREA OF WHITE LUNG IS SEEN AS CONSOLIDATED
TISSUE IS MORE RADIOOPAQUE

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