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Different Radiographs To Depict And Show Pleural Effusion In Affected Lungs (X-Ray Pictures)

Updated on February 6, 2014

Diagnosing With X-rays

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Introduction

A Pleural effusion is an excessive accumulation of fluid in the pleural space. It can be detected clinically when there is 500 mL or more present, and by plain Chest X-ray when there is more than 300 mL. Massive effusions are most commonly malignant in origin. A pleural effusion may be asymptomatic (if small) or cause breathlessness. The typical physical signs and chest X-ray appearances are shown in the pictures below.

Pleural Effusion In X-rays And DIagrams

Pleural effusion is excess fluid that accumulates between the two pleural layers, the fluid-filled space that surrounds the lungs. Excessive amounts of such fluid can impair breathing by limiting the expansion of the lungs during ventilation.
Pleural effusion is excess fluid that accumulates between the two pleural layers, the fluid-filled space that surrounds the lungs. Excessive amounts of such fluid can impair breathing by limiting the expansion of the lungs during ventilation. | Source
Pleural effusion is usually diagnosed on the basis of medical history and physical exam, and confirmed by chest x-ray. Once accumulated fluid is more than 300 ml,
Pleural effusion is usually diagnosed on the basis of medical history and physical exam, and confirmed by chest x-ray. Once accumulated fluid is more than 300 ml, | Source
 there are usually detectable clinical signs in the patient, such as decreased movement of the chest on the affected side, stony dullness to percussion over the fluid, diminished breath sounds on the affected side
there are usually detectable clinical signs in the patient, such as decreased movement of the chest on the affected side, stony dullness to percussion over the fluid, diminished breath sounds on the affected side | Source
decreased vocal resonance and fremitus (though this is an inconsistent and unreliable sign), and pleural friction rub.
decreased vocal resonance and fremitus (though this is an inconsistent and unreliable sign), and pleural friction rub. | Source
Above the effusion, where the lung is compressed, there may be bronchial breathing and egophony. In large effusion there may be tracheal deviation away from the effusion.
Above the effusion, where the lung is compressed, there may be bronchial breathing and egophony. In large effusion there may be tracheal deviation away from the effusion. | Source
A systematic review (2009) published as part of the Rational Clinical Examination Series in the Journal of the American Medical Association (JAMA) showed that dullness to conventional percussion was most accurate for diagnosing pleural effusion (summ
A systematic review (2009) published as part of the Rational Clinical Examination Series in the Journal of the American Medical Association (JAMA) showed that dullness to conventional percussion was most accurate for diagnosing pleural effusion (summ | Source
while the absence of reduced tactile vocal fremitus made pleural effusion less likely (negative likelihood ratio, 0.21; 95% confidence interval, 0.12–0.37).
while the absence of reduced tactile vocal fremitus made pleural effusion less likely (negative likelihood ratio, 0.21; 95% confidence interval, 0.12–0.37). | Source
A pleural effusion will show up as an area of whiteness on a standard posteroanterior X-ray. Normally the space between the two layers of the lung, the visceral pleura and the parietal pleura, cannot be seen.
A pleural effusion will show up as an area of whiteness on a standard posteroanterior X-ray. Normally the space between the two layers of the lung, the visceral pleura and the parietal pleura, cannot be seen. | Source
A pleural effusion infiltrates the space between these layers. Because the pleural effusion has a density similar to body fluid or water, it can be seen on radiographs. Since the effusion has greater density than the rest of the lung, it will gravita
A pleural effusion infiltrates the space between these layers. Because the pleural effusion has a density similar to body fluid or water, it can be seen on radiographs. Since the effusion has greater density than the rest of the lung, it will gravita | Source
The pleural effusion behaves according to basic fluid dynamics, conforming to the shape of the lung and chest cavity. If the pleural cavity contains both air and fluid, then the fluid will have a "fluid level" that is horizontal instead of conforming
The pleural effusion behaves according to basic fluid dynamics, conforming to the shape of the lung and chest cavity. If the pleural cavity contains both air and fluid, then the fluid will have a "fluid level" that is horizontal instead of conforming | Source
Chest radiographs acquired in the lateral decubitus position (with the patient lying on his side) are more sensitive and can pick up as little as 50 ml of fluid.
Chest radiographs acquired in the lateral decubitus position (with the patient lying on his side) are more sensitive and can pick up as little as 50 ml of fluid. | Source
At least 300 ml of fluid must be present before upright chest films can pick up signs of pleural effusion (e.g., blunted costophrenic angles).
At least 300 ml of fluid must be present before upright chest films can pick up signs of pleural effusion (e.g., blunted costophrenic angles). | Source
Definitions of the terms "transudate" and "exudate" are the source of much confusion. Briefly, transudate is produced through pressure filtration without capillary injury while exudate is "inflammatory fluid" leaking between cells.
Definitions of the terms "transudate" and "exudate" are the source of much confusion. Briefly, transudate is produced through pressure filtration without capillary injury while exudate is "inflammatory fluid" leaking between cells. | Source
Transudative pleural effusions are defined as effusions that are caused by systemic factors that alter the pleural equilibrium, or Starling forces.
Transudative pleural effusions are defined as effusions that are caused by systemic factors that alter the pleural equilibrium, or Starling forces. | Source
The components of the Starling forces–hydrostatic pressure, permeability, oncotic pressure (effective pressure due to the composition of the pleural fluid and blood)–are altered in many diseases, e.g., left ventricular failure, renal failure, hepatic
The components of the Starling forces–hydrostatic pressure, permeability, oncotic pressure (effective pressure due to the composition of the pleural fluid and blood)–are altered in many diseases, e.g., left ventricular failure, renal failure, hepatic | Source
Exudative pleural effusions, by contrast, are caused by alterations in local factors that influence the formation and absorption of pleural fluid (e.g., bacterial pneumonia, cancer, pulmonary embolism, and viral infection).
Exudative pleural effusions, by contrast, are caused by alterations in local factors that influence the formation and absorption of pleural fluid (e.g., bacterial pneumonia, cancer, pulmonary embolism, and viral infection). | Source
An accurate diagnosis of the cause of the effusion, transudate versus exudate, relies on a comparison of the chemistries in the pleural fluid to those in the blood, using Light's criteria
An accurate diagnosis of the cause of the effusion, transudate versus exudate, relies on a comparison of the chemistries in the pleural fluid to those in the blood, using Light's criteria | Source
The sensitivity and specificity of Light's criteria for detection of exudates have been measured in many studies and are usually reported to be around 98% and 80% respectively.
The sensitivity and specificity of Light's criteria for detection of exudates have been measured in many studies and are usually reported to be around 98% and 80% respectively. | Source
This means that although Light's criteria are relatively accurate, twenty percent of patients that are identified by Light's criteria as having exudative pleural effusions actually have transudative pleural effusions.
This means that although Light's criteria are relatively accurate, twenty percent of patients that are identified by Light's criteria as having exudative pleural effusions actually have transudative pleural effusions. | Source
Therefore, if a patient identified by Light's criteria as having an exudative pleural effusion appears clinically to have a condition that usually produces transudative effusions, additional testing is needed. In such cases albumin levels in blood an
Therefore, if a patient identified by Light's criteria as having an exudative pleural effusion appears clinically to have a condition that usually produces transudative effusions, additional testing is needed. In such cases albumin levels in blood an | Source

References

1. All X-ray photos here are from DFM E-Group, in the photo and X-ray section.

2. Notes and explanations: Wikipedia, Essentials of Clinical Medicine by Kumar and Clark's, Medicinenet and Mayor's Clinic.

© 2014 Funom Theophilus Makama

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      Leo 3 years ago

      Praying for you, Leah, and your husband and Beckett every day many times a day. I've been tugohrh difficult times with my oldest son being gravely ill when he was just a baby and needing emergency surgery, and my husband being ill for 10 years before losing him. I understand what it is like to not be able to be there with your loved one when that is the only thing you so desperately want to do, and the only place you want to be. Keep hanging in there and well keep praying for God to give all of you the courage, faith and strength to persevere day by day and in the times when it may be minute by minute. So glad for Beckett's good day today with you. Go Beckett!

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