CHAPTER 2 Respiratory System^113
Pleural Effusion
WHAT WENT WRONG?
Abnormal accumulation of fluid within the pleural space between the parietal and
visceral pleura covering the lungs. The fluid may be serous fluid, blood (hemoth-
orax), or pus (empyema). Fluid builds up when the development of the fluid
exceeds the body’s ability to remove the fluid. Excess fluid inhibits full expansion
of the lung. A large area of fluid build-up will displace the lung tissue, compro-
mising air exchange in the area. As fluid builds up and takes the place of lung tis-
sue, it may push the collapsing lung past the middle (mediastinum) of the chest.
This displaces the central structures, compromising the air exchange of the other
lung as well. Causes of pleural effusion are varied and include congestive heart
failure, renal failure, malignancy, lupus erythematosis, pulmonary infarction, infec-
tion, or trauma. It can also occur as a postoperative complication.
PROGNOSIS
Prognosis varies depending on cause and amount of fluid present. Once fluid is
removed, patient is monitored to see if fluid builds up again. The fluid may need
to be removed periodically, depending on the cause.
HALLMARK SIGNS AND SYMPTOMS
- Chest pain due to presence of inflammation of the pleura in the area; not
always present. - Difficulty breathing (dyspnea) due to diminished chest expansion in the
area. - Decreased breath sounds on auscultation over the area due to presence of
fluid. - Dullness on percussion over the affected area due to the presence of fluid.
- Fever due to infection with empyema.
- Increased pulse and respirations; decreased BP due to blood loss with hemo-
thorax. - Low oxygen saturation on pulse oximeter.
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