Typical symptoms of a pleural effusion include: 1 As the pleural effusion increases in size, symptoms begin to develop. Small and moderate pleural effusions are commonly asymptomatic. Rare: yellow nail syndrome, drugs (methotrexate, amiodarone, nitrofurantoin, phenytoin)Ĭhylothorax: chyle in the pleural space due to disruption of the thoracic duct (due to a neoplasm, trauma or infection/inflammation) rheumatoid arthritis), pancreatitis, post-myocardial infarction (Dressler’s syndrome), post coronary artery bypass grafting, asbestos Less common: pulmonary infarction, autoimmune diseases (e.g. Rare: Meigs’ syndrome (benign ovarian tumour, ascites, pleural effusion)Ĭommon: infection (parapneumonic, tuberculosis), malignancy Less common: hypoalbuminemia, nephrotic syndrome, peritoneal dialysis, hypothyroidism 1 TypeĬommon: ‘the failures’: heart failure, cirrhosis (liver failure) An overview of the causes of pleural effusions. Fluid accumulates due to increased pleural and capillary permeability. Transudates have a low protein level of 35g/L. Pleural effusions are usually classified as transudative or exudative. Anatomy of the chest wall and pleural membranes. Pleural effusions occur when fluid accumulates in the pleural space. The serous fluid allows the visceral and parietal pleura to slide over each other during respiration and creates surface tension between the two layers. The potential space between the visceral and parietal pleura contains a small amount of lubricating serous fluid. This is a serous membrane divided into the visceral pleura (lines the lungs) and parietal pleura (lines the internal thoracic cavity). The lungs are surrounded by the pleural membrane. In the appropriate clinical setting of acute dyspnea, but equivocal breath sounds, EMS providers may percuss the thorax for unilateral hyper-resonance and asymmetric tactile fremitus in making the diagnosis.Ĭopyright © 2024, StatPearls Publishing LLC.Want discounted access to all Geeky Medics products, including our medicine flashcard collection? Check out our bundles to save money and supercharge your learning 🔥 Aetiology Anatomy Low light, body fluid, and other environmental factors may make otherwise obvious chest wall openings unapparent in emergencies.

Definitive treatment of both conditions may require a chest tube depending on the level of severity, but only a tension pneumothorax will require needle decompression.Īmbient noise in the field may drown out differences in lateralized breath sounds. A key clinical finding that separates these two is that a pneumothorax will have hyper-resonance to percussion, but a hemothorax will have a hypo-resonance to percussion. A hemothorax will have a similar presentation as a pneumothorax, with symptoms such as dyspnea, hypoxia, decreased breath sounds, and chest pain. Many patients will have comorbid conditions that may mimic a pneumothorax including COPD/asthma, congestive heart failure (CHF), and pleural effusions, which may cause decreased breath sounds during acute exacerbations and acute dyspnea. They do not have access to emergency department diagnostic equipment such as chest radiographs and point of care thoracic ultrasound which may clinch the diagnosis. EMS providers may be called to the outpatient setting where medical procedures involving the chest or neck may cause an iatrogenic pneumothorax, such as central venous catheter placement, thoracentesis, and lung biopsies.ĮMS providers are challenged in making the diagnosis for several reasons. EMS providers may also encounter several different mechanisms of injury that violate the pleura creating a pneumothorax, such as penetrating trauma to the chest or blunt trauma with a rib fracture. It can also occur secondarily as a part of a chronic lung disease such as chronic obstructive pulmonary disease (COPD), interstitial lung disease, or pneumocystis pneumonia (PCP) due to the destruction of lung tissue. Lung tissue can spontaneously rupture in patients with risk factors such as tobacco use, Marfan’s syndrome, underwater diving, airplane travel, and male gender.

$resonance lung sounds$

Air can enter the chest cavity from a disrpution in the lung tissue or trauma to the pleura. Pneumothorax is the entry of air into the potential space between the parietal and visceral pleura. The condition spans all age groups, and EMS providers should, therefore, maintain a high index of suspicion for pneumothorax for any patient with a sudden onset of acute respiratory distress and ipsilateral chest pain. It is commonly associated with complaints such as chest pain, shortness of breath, and trauma.

Pneumothorax is a principal diagnosis for emergency medical services (EMS) providers to identify, which is a potentially life-threatening condition.

Resonance lung sounds