Investigation of Pleural Effusions

Investigation of Pleural Effusions

Introduction

Pleural effusion is a common medical condition which often presents on the AMU. There are more than 50 recognised causes of pleural effusion which include diseases local to the pleura or underlying lung, systemic conditions, organ dysfunction and drugs.1 The normal pleural space contains approximately 1mL of fluid. The balance between hydrostatic and oncotic pressures in the visceral and parietal pleural vessels maintains this environment; any disorder affecting this balance will result in a pleural effusion.

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Investigation of Pleural Effusions

10th March 2016
Authors Affiliations
Luaie Idris Respiratory ST4 Respiratory Department Queen Alexandra Hospital Southwick Hill Road Cosham, PO6 3LY
Nilushi Ranaweera Respiratory SPR (ST3) Respiratory Department Poole Hospital Longfleet Road Poole Dorset BH15 2JB
Diane Laws FRCP Consultant Physician Department of Thoracic Medicine Royal Bournemouth Hospital Castle Lane East Bournemouth, Dorset, BH7 7DW

Investigation of Pleural Effusions

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Investigation of Pleural Effusions

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