![]() Ultrasound of the chest is more sensitive and useful for the diagnosis of pleural effusion and also helps in planning thoracentesis. However, in a lateral view, 50 ml of fluid can be diagnosed with this sign. On an upright posteroanterior (PA) view, a minimum of 200 ml of fluid is required to obliterate the costophrenic angle, called the meniscus sign of a pleural effusion. The findings of effusion vary with the amount of effusion. For example, in congestive heart failure (CHF), examine for jugular venous distension, S3, and pedal edema in cirrhosis leading to hepatic hydrothorax, look for ascites and other stigmata of liver disease.Ĭhest radiographs are useful to confirm the presence of effusion. Pleural rubs, often mistaken for coarse crackles, can be heard during active pleurisy without any effusion.Īs pleural effusion is the result of varied diseases, history and physical examination should also be focused on the underlying pulmonary or systemic cause of the effusion. Egophony is most pronounced at the superior aspect of the effusion. Auscultation reveals decreased breath sounds and decreased tactile and vocal fremitus. In large effusion, there will be the fullness of intercostal spaces and dullness on percussion on that side. Depending on the cause of effusion, the patient can also complain of a cough, fever, and systemic symptoms. Constant pain is also a hallmark of malignant diseases like mesothelioma. When the effusion develops, pain can subside, falsely implying an improvement in condition. Patient with active pleural inflammation called pleurisy complains of sharp, severe, localized crescendo/ decrescendo pain with breathing or a cough. ![]() ![]() A patient with pleural effusion can be asymptomatic or can present with exertional breathlessness depending on the impairment of thoracic excursion. ![]()
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