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CLINICAL SIGNS OF
PLEURAL EFFUSION

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SYMPTOMS
DYSPNEA

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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

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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

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? 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

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POSTEROANTERIOR VIEW
? VANISHING PULMONARY TUMOUR IS USED FOR
INTERLOBAR EFFUSION

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OTHER FINDINGS
? TUBERCULOUS EFFUSION-STAW COLOURED

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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

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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

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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

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ABSENCE OF NORMAL LUNG MARGINS
OUTER MARGINS OF THE COLLAPSED LUNG
SEEN AS SHARP MARGIN AGAINST
BACKGROUND OF AIR
TRACHEA AND MEDIASTINUM SHIFTED TO

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OPPOSITE SIDE

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

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ABOVE IT

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SIGNS
EXPANSION OF THORAX ON INSPIRATION ON
AFFECTED SIDE
VOCAL FREMITUS IS INCREASED ON AFFECTED SIDE

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PERCUSSION DULL IN AFFECTED SIDE
BREATH SOUDS ARE BRONCHIAL
POSSIBLE MEDIUM ,LATE,OR PAN INSPIRATORY
CRACKLES
VOCAL RESONANCE INCREASED

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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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