Pleural Effusions: Diagnostic Considerations

The presence of fluid in the pleural space can be seen in a variety of disorders. Presenting symptoms include dyspnea, pleuritic chest pain, and ipsilateral shoulder pain if pleural involvement occurs at the central portion of the diaphragm. Physical examination findings include chest asymmetry, diminished breath sounds, dullness to percussion, and decreased tactile fremitus. In an upright patient, the radiographic appearance of pleural fluid includes blunting of the costophrenic angle, straightening or a more lateral peak of the hemidiaphragm contour, simulation of an elevated hemidiaphragm, or a distance of greater than 2 cm between the gastric air bubble and the lung.

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Clinical study of community acquired pneumonia at MNR medical college and hospital, Sangareddy

International Journal of Clinical Trials ◽

10.18203/2349-3259.ijct20180134 ◽

2018 ◽

Vol 5 (1) ◽

pp. 73

Author(s):

Sonal Jain

Keyword(s):

Chest Pain ◽

Clinical Manifestations ◽

Acute Onset ◽

Community Acquired Pneumonia ◽

Medical College ◽

Presenting Symptoms ◽

Breath Sounds ◽

Medical Wards ◽

Associated Risk Factors ◽

Hospital Acquired

Background: This study is done to study the clinical profile of community acquired pneumonia in patients admitted in medical wards at MNR Hospital, Sangareddy and to find out the associated risk factors of community acquired pneumonia.Methods: 75 Patients admitted in the department of medicine of MNR Medical college and Hospital, Sangareddy with clinical manifestations of Community acquired pneumonia from august 2012 to January 2015 (Two years and 6 months) were taken into the study. All adult patients of both genders aged above 14 yrs, who presented with acute onset of fever associated with chills and rigors, having cough with expectoration and/ or chest pain and breathlessness were included in the study. All the patients were subjected for detailed clinical examination to make a provisional diagnosis of community acquired pneumonia (CAP). Patients with hospital acquired pneumonia, aspiration pneumonia and PCP pneumonia in patients with HIV were excluded.Results: Among 75 cases studied, the mean patient age was 52.1 years with Male: Female patient ratio 3.17:1. The associated diseases in this study are COPD (30.67%) and DM (12.0%).The most common presenting symptoms were fever (100%), cough (100%), and expectoration (100%); other symptoms included chest pain (60%), dyspnoea (61.33%). The respiratory signs included bronchial breath sounds, increased VF and VR, and presence of whispering pectorolique in all subjects. Conclusions: Identification and determining the clinical patterns of community acquired pneumonia helps in adoption of regionally optimized diagnostic approach.

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Pneumothorax

Oxford Handbook of Respiratory Nursing ◽

10.1093/med/9780198831815.003.0018 ◽

2021 ◽

pp. 455-462

Author(s):

Terry Robinson ◽

Jane Scullion

Keyword(s):

Risk Factors ◽

Chest Pain ◽

Nursing Care ◽

Pregnant Patient ◽

Pleural Space ◽

Pleuritic Chest Pain ◽

Management Options ◽

Younger Patients ◽

Affected Side ◽

Incidence Risk

A pneumothorax is defined as air in the pleural space. It can be spontaneous, occur as the result of trauma, or be iatrogenic. Patients with a pneumothorax commonly present with pleuritic chest pain on the affected side and/or breathlessness. Younger patients often have minimal breathlessness although in secondary pneumothorax breathlessness may be increased. A pneumothorax will reduce the compliance of the lungs and so the lungs will become stiffer. Because of reduced compliance in the affected lung greater pressure needs to be generated during inspiration to move the same volume of air into the lungs. As a result, breathing will become more of an effort and the sensation of breathlessness will be increased. The patient may also have pleuritic chest pain from inflammation of the pleura, generally due to bleeding, and heightened by attempts to inflate the affected lung. This chapter covers the incidence, risk factors, features, and investigations of the condition, different management options and prognosis, and different aspects of nursing care. Practical care of chest drains and management of the pregnant patient is also covered.

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Vertebral osteomyelitis presenting with pleuritic chest pain and bilateral pleural effusions

Thorax ◽

10.1136/thx.47.5.395 ◽

1992 ◽

Vol 47 (5) ◽

pp. 395-396 ◽

Cited By ~ 8

Author(s):

P J Sullivan ◽

D Currie ◽

J V Collins ◽

D J Johnstone ◽

A Morgan

Keyword(s):

Chest Pain ◽

Vertebral Osteomyelitis ◽

Pleural Effusions ◽

Pleuritic Chest Pain

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Benign Teratoma in the Left Pleural Space with Amylase in the Pleural Fluid

Canadian Respiratory Journal ◽

10.1155/1996/868456 ◽

1996 ◽

Vol 3 (3) ◽

pp. 193-196

Author(s):

C Dale Guenter ◽

Gregory A Grant ◽

Robert H Walker ◽

Gordon T Ford

Keyword(s):

Computed Tomography ◽

Chest Pain ◽

Pleural Fluid ◽

Cystic Teratoma ◽

Pleural Space ◽

Pleuritic Chest Pain ◽

Left Hemidiaphragm ◽

Benign Cystic Teratoma ◽

Benign Teratoma

The case of a 28-year-old man who experienced repeated episodes of pleuritic chest pain is reported. Eventual discovery of amylase in the pleural fluid and a supradiaphragmatic mass on computed tomography led to exploratory thoracotomy. A benign cystic teratoma was discovered in the pleural space overlying the left hemidiaphragm and connected by a peduncle to the thymus.

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CLINICAL SYMPTOMS, BIOCHEMISTRY AND CYTOLOGY OF PLEURAL, PERITONEAL EFFUSIONS

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2015.6.10 ◽

2016 ◽

pp. 66-71

Author(s):

Van Mao Nguyen ◽

Huyen Quynh Trang Pham

Keyword(s):

Pleural Effusion ◽

Clinical Symptoms ◽

Cross Sectional Study ◽

Malignant Cells ◽

Sectional Study ◽

Pleural Effusions ◽

Cross Sectional ◽

Breath Sounds ◽

Peritoneal Effusion ◽

Neutrophil Leukocytes

Background: The cytology and the support of clinical symptoms, biochemistry for diagnosis of the cases of effusions are very important. Objectives: - To describe some of clinical symptoms and biochemistry of effusions. - To compare the results between cytology and biochemistry by the causes of pleural, peritoneal fluids. Material & Method: A cross-sectional study to describe all of 47 patients with pleural, peritoneal effusions examinated by cytology in the Hospital of Hue University of Medicine and Pharmacy from April 2013 to January 2014. Results: In 47 cases with effusions, pleural effusion accounting for 55.32%, following peritoneal effusions 29.79% and 14.89% with both of them. The most common symptoms in patients with pleural effusions were diminished or absent tactile fremitus, dull percussion, diminished or absent breath sounds (100%), in patients with peritoneal effusions was ascites (95.24%). 100% cases with pleural effusions, 50% cases with peritoneal effusions and 80% cases with pleural and peritoneal effusions were exudates. The percentage of malignant cells in patients with pleural effusions was 26.92%, in peritoneal effusions was 28.57%, in pleural and peritoneal effusions was 42.86%. The percentage of detecting the malignant cells in patients with suspected cancer in the first test was 57.14%, in the second was 9.53% and 33.33% undetectable. Most of cases which had malignant cells and inflammatory were exudates, all of the cases which had a few cells were transudates. Besides, 7.5% cases which had high neutrophil leukocytes were transudates. Conclusion: Cytology should be carry out adding to the clinical examinations and biochemistry tests to have an exact diagnosis, especially for the malignant ones. For the case with suspected cancer, we should repeat cytology test one more time to increase the ability to detect malignant cells. Key words: Effusion, pleural effusion, peritoneal effusion, cytology, biochemistry

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Oxford Cases in Medicine and Surgery

10.1093/oso/9780198716228.001.0001 ◽

2015 ◽

Author(s):

Hugo Farne ◽

Edward Norris-Cervetto ◽

James Warbrick-Smith

Keyword(s):

Chest Pain ◽

Case History ◽

Clinical Medicine ◽

Real Life ◽

General Medicine ◽

Diagnostic Approach ◽

History Taking ◽

Presenting Symptoms ◽

Essential Resource ◽

Physiological Systems

Oxford Cases in Medicine and Surgery, second edition, teaches students a logical step-by-step diagnostic approach to common patient presentations. This approach mirrors that used by successful clinicians on the wards, challenging students with questions at each stage of a case (history-taking, examination, investigation, management). In tackling these questions, students understand how to critically analyse information and learn to integrate their existing knowledge to a real-life scenario from start to finish. Each chapter focuses on a common presenting symptom (e.g. chest pain). By starting with a symptom, mirroring real life settings, students learn to draw on their knowledge of different physiological systems - for example, cardiology, respiratory, gastroenterology - at the same time. All the major presenting symptoms in general medicine and surgery are covered, together with a broad range of pathologies. This book is an essential resource for all medicine students, and provides a modern, well-rounded introduction to life on the wards. Ideal for those starting out in clinical medicine and an ideal refresher for those revising for OSCEs and finals.

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Twenty-three year-old with pleuritic chest pain

Heart ◽

10.1136/heartjnl-2017-312718 ◽

2018 ◽

Vol 105 (6) ◽

pp. 464-469

Author(s):

Karina P Gopaul ◽

Helen M Parry ◽

Damien Cullington

Keyword(s):

Chest Pain ◽

Congenital Heart ◽

White Cell Count ◽

Coarctation Of The Aorta ◽

List Type ◽

Pleuritic Chest Pain ◽

Reactive Protein ◽

Pulmonary Angiogram ◽

Night Sweats ◽

Ct Pulmonary Angiogram

Clinical introductionA 23-year-old woman followed at another medical centre for congenital heart disease (CHD) presented to our emergency clinic with 3 weeks of bilateral pleuritic chest pain. She returned from holiday in Greece 6 weeks earlier where a tattoo and nasal piercing had been performed. There was no history of night sweats or fever.Her temperature was 37.5°C, heart rate 120 beats/min, oxygen saturations 94% on room air and blood pressure 110/74. Her chest was clear and there was systolic murmur on auscultation. The chest radiograph showed peripheral bilateral lower zone atelectasis. The ECG demonstrated sinus tachycardia. The haemoglobin was 11.2 g/dL, white cell count 10.18×109/L, C-reactive protein 67 mg/L (normal <5 mg/L) and D dimer=430 ng/mL (normal <230 ng/mL).A pulmonary embolus was suspected and a CT pulmonary angiogram was performed (figure 1).QuestionBased on the CT findings, what is the most likely underlying congenital heart lesion in this patient?Bicuspid aortic valveCoarctation of the aortaFontan circulationParachute mitral valveVentricular septal defectFigure 1CT pulmonary angiogram (coronal views).

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Acute Pleuritic Chest Pain and Lung Mass in an Elderly Woman

CHEST Journal ◽

10.1378/chest.97.6.1473 ◽

1990 ◽

Vol 97 (6) ◽

pp. 1473-1474 ◽

Cited By ~ 9

Author(s):

Denis D. Bensard ◽

John A. St. Cyr ◽

Michael R. Johnston

Keyword(s):

Chest Pain ◽

Elderly Woman ◽

Lung Mass ◽

Pleuritic Chest Pain

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A rare case of spontaneous haemothorax in patient with haemophilia A

BMJ Case Reports ◽

10.1136/bcr-2021-242412 ◽

2021 ◽

Vol 14 (4) ◽

pp. e242412

Author(s):

Suthaphong Tripoppoom ◽

Nophol Leelayuwatanakul

Keyword(s):

Chest Pain ◽

Rare Case ◽

Rare Event ◽

Haemophilia A ◽

Minor Trauma ◽

Conservative Approach ◽

Pleuritic Chest Pain ◽

Good Clinical Outcome ◽

History Of

Haemorrhage in patients with haemophilia is common after minor trauma but may occur spontaneously. Despite the diversity of bleeding sites, spontaneous haemothorax, on a non-traumatic basis, is an exceedingly rare event and only a few cases had been reported. We present a case of a 43-year-old man with a history of haemophilia A who had pleuritic chest pain for 1 day without significant history of trauma. Diagnostic thoracentesis showed bloody pleural fluid in which neither abnormal cell nor organism was found. He was treated by cryoprecipitate replacement and therapeutic thoracentesis for releasing haemothorax. After discharge, the patient returned for follow-up with complete radiological resolution. Regarding the consequences of retained haemothorax from conservative approach and the procedure-related bleeding of given therapeutic intervention in haemothorax making its management in patients with haemophilia to be more challenging. Our case illustrates a conservative treatment of spontaneous haemothorax in patient with haemophilia resulting in a good clinical outcome.

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Suspected acute rheumatic fever in a young man in England

BMJ Case Reports ◽

10.1136/bcr-2021-244469 ◽

2021 ◽

Vol 14 (11) ◽

pp. e244469

Author(s):

Zak Michael Wilson ◽

Katie Craster

Keyword(s):

Chest Pain ◽

General Practitioner ◽

Mitral Regurgitation ◽

Rheumatic Fever ◽

Acute Rheumatic Fever ◽

Supportive Therapy ◽

Acute Hospital ◽

Shortness Of Breath ◽

Pleural Effusions ◽

Pericardial Thickening

A 24-year-old fit and well Caucasian man was referred to acute hospital via his General Practitioner with chest pain, palpitations, shortness of breath and an antecedent sore throat. Investigations revealed pericardial and pleural effusions, pericardial thickening on MRI, mild mitral regurgitation on echocardiogram and a raised Antistreptolysin O (ASO) titre.He was treated as acute rheumatic fever (ARF) with a prolonged course of penicillin, supportive therapy with bisoprolol and colchicine with lansoprazole cover. The patient made a full recovery and subsequent cardiac MRI showed resolution of all changes.

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