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Efusi pleura

Summary of Pleural Effusion: Ringkasan efusi pleura:


Sebuah efusi pleura adalah akumulasi kelebihan cairan dalam rongga pleura di paru-paru.
Penyebab umum dari efusi pleura termasuk gagal jantung kongestif, sindroma nefrotik,
radang paru-paru, dan kanker paru-paruefusi pleura dapat menyebabkan gejala sama
sekali, atau mungkin menghasilkan sakit dada tajam, sesak napas dan batuk kering.
Pengobatan ditujukan pada penyebab yang mendasari, dan gejala dapat menghidupkan
kembali oleh Thoracentesis (pengeringan fluida).
Apa yang dimaksud dengan efusi pleura?
Sebuah efusi pleura adalah akumulasi kelebihan cairan dalam rongga pleura di paru-paru.
Pleura ini adalah selaput tipis yang menutupi paru-paru dan garis bagian dalam rongga
dada.. 'uang pleura' menggambarkan ruang kecil di antara lapisan dalam dan luar pleura,
yang biasanya mengandung sejumlah kecil cairan pelumas pleura untuk memungkinkan
paru-paru untuk terus berkembang tanpa gesekan. !airan ini terus-menerus terbentuk
melalui kebocoran cairan dari kapiler di dekatnya dan kemudian kembali sistem limfatik
diserap oleh tubuh.
"engan efusi pleura, beberapa ketidakseimbangan antara produksi dan reabsorpsi cairan
pleura mengarah ke membangun kelebihan cairan dalam ruang pleura.
There are t#o major types of pleural effusion$ %da dua jenis utama dari efusi pleura$
Transudati&e effusions, #here the e'cess pleural fluid is lo# in protein( and
Transudati&e efusi, di mana cairan pleura kelebihan rendah protein, dan
)'udati&e effusions, #here the e'cess pleural fluid is high in protein. )'udati&e
efusi, di mana cairan pleura kelebihan protein tinggi.
Penyebab efusi pleura
%nything that causes an imbalance bet#een production and reabsorption of pleural fluid
can lead to de&elopment of a pleural effusion. %pa saja yang menyebabkan
ketidakseimbangan antara produksi dan reabsorpsi cairan pleura dapat mengarah pada
pembangunan sebuah efusi pleura.
Transudati&e pleural effusions (those lo# in protein) usually form as a result of e'cess
capillary fluid leakage into the pleural space. efusi pleura Transudati&e (yang rendah
protein) biasanya membentuk akibat kelebihan cairan kebocoran kapiler ke dalam ruang
pleura. !ommon causes of transudati&e effusions include$ Penyebab umum dari efusi
transudati&e meliputi$
!ongesti&e heart failure( *ongestif gagal jantung(
+ephrotic syndrome( Sindrom nefrotik(
!irrhosis of the li&er( Sirosis hati(
Pulmonary embolism( and )mboli paru( dan
,ypothyroidism. ,ypothyroidism.
http://www.madelinelester.com/07080/07080.htm
Efusi pleura
-. of this page$ http$//###.nlm.nih.go&/medlineplus/ency/article/000012.htm -.
halaman$ http$//###.nlm.nih.go&/medlineplus/ency/article/000012.htm
% pleural effusion is an accumulation of fluid bet#een the layers of tissue that line the
lungs and chest ca&ity. Sebuah efusi pleura adalah akumulasi cairan di antara lapisan
jaringan yang melapisi paru-paru dan rongga dada.
!auses Penye"a"
!auses Penye"a"
3our body produces pleural fluid in small amounts to lubricate the surfaces of the pleura,
the thin tissue that lines the chest ca&ity and surrounds the lungs. Tubuh %nda
menghasilkan cairan pleura dalam jumlah kecil untuk melumasi permukaan pleura,
jaringan tipis yang melapisi rongga dada dan sekitarnya paru-paru. % pleural effusion is
an abnormal, e'cessi&e collection of this fluid. Sebuah efusi pleura adalah pengumpulan,
abnormal cairan ini berlebihan.
T#o different types of effusions can de&elop$ "ua jenis efusi dapat mengembangkan$
Transudati&e pleural effusions are caused by fluid leaking into the pleural space.
efusi pleura Transudati&e disebabkan oleh cairan bocor ke ruang pleura. This is
caused by ele&ated pressure in, or lo# protein content in, the blood &essels.
!ongesti&e heart failure !ongesti&e heart failure is the most common cause. ,al
ini disebabkan oleh tekanan tinggi, atau kadar protein rendah, pembuluh darah.
kongestif gagal jantung gagal jantung kongestif merupakan penyebab paling
umum.
)'udati&e effusions usually result from leaky blood &essels caused by
inflammation (irritation and s#elling) of the pleura. )'udati&e efusi biasanya
hasil dari pembuluh darah bocor disebabkan oleh peradangan (iritasi dan
bengkak) dari pleura. This is often caused by lung disease. ,al ini sering
disebabkan oleh penyakit paru-paru. )'amples include lung cancer lung cancer ,
lung infections such as tuberculosis tuberculosis and pneumonia pneumonia , drug
reactions, and asbestosis asbestosis . !ontohnya termasuk kanker paru kanker
paru-paru, infeksi paru-paru seperti tuberkulosis tuberkulosis dan pneumonia
radang paru-paru, reaksi obat, dan asbestosis asbestosis.
Symptoms #e$ala
Symptoms #e$ala
!hest pain !hest pain , usually a sharp pain that is #orse #ith cough or deep
breaths "ada nyeri dada nyeri, biasanya nyeri tajam yang buruk dengan batuk
atau napas dalam-dalam
!ough !ough 4atuk 4atuk
5e&er "emam
,iccups ,iccups !egukan cegukan
apid breathing apid breathing apid bernapas cepat bernapas
Shortness of breath Shortness of breath Sesak napas Sesak napas
Sometimes there are no symptoms. *adang-kadang tidak ada gejala.
E%ams and &ests '$ian dan &es
E%ams and &ests '$ian dan &es
"uring a physical e'amination, the doctor #ill listen to the sound of your breathing #ith
a stethoscope and may tap on your chest to listen for dullness. Selama pemeriksaan fisik,
dokter akan mendengarkan suara napas %nda dengan stetoskop dan mungkin tekan pada
dada %nda untuk mendengarkan kebodohan.
The follo#ing tests may help to confirm a diagnosis$ Tes berikut dapat membantu untuk
mengkonfirmasikan diagnosis$
!hest '-ray !hest '-ray 6-ray dada dada '-ray
Pleural fluid analysis Pleural fluid analysis (e'amining the fluid under a
microscope to look for bacteria, amount of protein, and presence of cancerous
cells) %nalisis cairan pleura analisis cairan pleura (memeriksa cairan di ba#ah
mikroskop untuk mencari bakteri, jumlah protein, dan kehadiran sel-sel kanker)
Thoracentesis Thoracentesis (a sample of fluid is remo&ed #ith a needle inserted
bet#een the ribs) Thoracentesis Thoracentesis (contoh fluida dihapus dengan
jarum disisipkan di antara tulang rusuk)
Thoracic !T Thoracic !T !T toraks Thoracic !T
-ltrasound of the chest -S7 dada
&reatment Pengo"atan
&reatment Pengo"atan
Treatment may be directed at remo&ing the fluid, pre&enting it from accumulating again,
or addressing the underlying cause of the fluid buildup. Pengobatan mungkin diarahkan
pada mengeluarkan fluida, mencegah dari mengumpulkan lagi, atau mengatasi penyebab
yang mendasari penumpukan cairan.
Therapeutic thoracentesis may be done if the fluid collection is large and causing
pressure, shortness of breath, or other breathing problems, such as lo# o'ygen le&els.
Thoracentesis Terapi dapat dilakukan jika koleksi fluida dan tekanan besar yang
menyebabkan, sesak napas, atau masalah pernapasan, seperti tingkat oksigen rendah.
emo&ing the fluid allo#s the lung to e'pand, making breathing easier. 8enghapus
fluida memungkinkan untuk memperluas paru-paru, membuat bernapas lebih mudah.
Treating the underlying cause of the effusion then becomes the goal. 8engobati
penyebab dari efusi kemudian menjadi tujuan.
5or e'ample, pleural effusions caused by congesti&e heart failure are treated #ith
diuretics (#ater pills) and other medications that treat heart failure. Sebagai contoh, efusi
pleura disebabkan oleh gagal jantung kongestif yang diobati dengan diuretik (pil air) dan
obat lain yang mengobati gagal jantung. Pleural effusions caused by infection are treated
#ith appropriate antibiotics. efusi pleura yang disebabkan oleh infeksi diobati dengan
antibiotik yang sesuai. 9n people #ith cancer or infections, the effusion is often treated by
using a chest tube for se&eral days to drain the fluid. !hemotherapy !hemotherapy ,
radiation therapy radiation therapy , surgery, or instilling medication into the chest that
pre&ents re-accumulation of fluid after drainage may be used in some cases. Pada orang
dengan kanker atau infeksi, efusi sering diperlakukan dengan menggunakan tabung dada
selama beberapa hari untuk mengalirkan fluida. *emoterapi *emoterapi, terapi radiasi
terapi radiasi, operasi, atau obat menanamkan ke dalam dada yang mencegah kembali
setelah akumulasi cairan drainase dapat digunakan dalam beberapa kasus.
(utlook )Prognosis* (utlook )Prognosis*
(utlook )Prognosis* (utlook )Prognosis*
The e'pected outcome depends upon the underlying disease. ,asil yang diharapkan
tergantung pada penyakit yang mendasari.
Possi"le !omplications +emungkinan +omplikasi
Possi"le !omplications +emungkinan +omplikasi
% lung surrounded by e'cess fluid for a long time may collapse. Sebuah paru-paru
dikelilingi oleh kelebihan cairan untuk #aktu yang lama mungkin runtuh.
Pleural fluid that becomes infected may turn into an abscess, called an empyema,
#hich re:uires prolonged drainage #ith a chest tube placed into the fluid. cairan
pleura yang terinfeksi akan beralih menjadi abses, disebut empiema sebuah, yang
memerlukan drainase lama dengan tabung dada ditempatkan ke dalam fluida.
Pneumothora' Pneumothora' (air #ithin the chest ca&ity) can be a complication
of the thoracentesis procedure. Pneumotoraks Pneumotoraks (udara dalam rongga
dada) bisa menjadi komplikasi dari prosedur Thoracentesis.
http://www.nlm.nih.go,/medlineplus/ency/article/00008.htm
Latar belakang
8any benign and malignant diseases can cause pleural effusion . penyakit jinak dan
ganas 4anyak dapat menyebabkan efusi pleura . The characteristics of the fluid depend
on the underlying pathophysiologic mechanism. *arakteristik cairan tergantung pada
mekanisme pathophysiologic mendasarinya. The fluid can be transudate, nonpurulent
e'udate, pus, blood, or chyle. fluida dapat transudate, eksudat nonpurulent, nanah, darah,
atau chyle. 9maging studies are &aluable in detecting and managing pleural effusions but
not in accurately characteri;ing the biochemical nature of the fluid. Studi 9maging
berharga dalam mendeteksi dan mengelola efusi pleura tetapi tidak dalam akurat
menggambarkan sifat biokimia fluida. 9mages of pleural effusion are sho#n belo#.
7ambar dari efusi pleura adalah sebagai berikut.
!ross-sectional !& image of the chest was o"tained during !&-guided "iopsy. !ross-
sectional !& citra dada diperoleh selama-di"im"ing "iopsi !&. .ote the
dependent location of the small left pleural effusion in the anterior aspect of
the left hemithora% )arrow*. !atatan lokasi tergantung dari efusi pleura
kiri kecil pada aspek anterior dari hemithora% kiri )panah*.
< !.=S) >9+"=> ? < !.=S) >9+"=> ?
!ross-sectional !& image of the chest was o"tained during !&-guided "iopsy. !ross-
sectional !& citra dada diperoleh selama-di"im"ing "iopsi !&. .ote the
dependent location of the small left pleural effusion in the anterior aspect of
the left hemithora% )arrow*. !atatan lokasi tergantung dari efusi pleura
kiri kecil pada aspek anterior dari hemithora% kiri )panah*.
!& image at the le,el of the lower chest in a patient with "oth ascites and right-sided
effusion. !& gam"ar pada tingkat yang le"ih rendah di dada pasien dengan
kedua ascites dan efusi sisi kanan. &he ne%t image is the same section with
illustrati,e la"eling. #am"ar "erikutnya adalah "agian yang sama dengan
la"el ilustrasi. &he ascites is marked on the right side "y the "lue color on
the illustrati,e image. &he ascites ditandai di sisi kanan dengan warna "iru
pada gam"ar ilustrasi. &he effusion is yellow/ and a small portion of the
right lung is pink. efusi adalah kuning/ dan se"agian kecil dari paru-paru
kanan pink. &he diaphragm is indicated "y a red arrow. 0iafragma
ditun$ukkan oleh panah merah. .ote that the interface "etween the effusion
and the li,er )yellow arrows* is less defined than the interface "etween the
li,er and ascites )"lue arrows*. Perhatikan "ahwa antarmuka antara efusi
dan hati )panah kuning* kurang didefinisikan daripada antarmuka antara
hati dan asites )panah "iru*. .ote that the effusion/ unlike ascites/ e%tends
posterior to the "are area of the li,er. Perhatikan "ahwa efusi/ tidak seperti
asites/ posterior meluas ke area telan$ang hati.
< !.=S) >9+"=> ? < !.=S) >9+"=> ?
!& image at the le,el of the lower chest in a patient with "oth ascites and right-sided
effusion. !& gam"ar pada tingkat yang le"ih rendah di dada pasien dengan
kedua ascites dan efusi sisi kanan. &he ne%t image is the same section with
illustrati,e la"eling. #am"ar "erikutnya adalah "agian yang sama dengan
la"el ilustrasi. &he ascites is marked on the right side "y the "lue color on
the illustrati,e image. &he ascites ditandai di sisi kanan dengan warna "iru
pada gam"ar ilustrasi. &he effusion is yellow/ and a small portion of the
right lung is pink. efusi adalah kuning/ dan se"agian kecil dari paru kanan
adalah pink. &he diaphragm is indicated "y a red arrow. 0iafragma
ditun$ukkan oleh panah merah. .ote that the interface "etween the effusion
and the li,er )yellow arrows* is less defined than the interface "etween the
li,er and ascites )"lue arrows*. Perhatikan "ahwa antarmuka antara efusi
dan hati )panah kuning* kurang didefinisikan daripada antarmuka antara
hati dan asites )panah "iru*. .ote that the effusion/ unlike ascites/ e%tends
posterior to the "are area of the li,er. Perhatikan "ahwa efusi/ tidak seperti
asites/ posterior meluas ke area telan$ang hati.
1llustrati,e image representing the !& section in the pre,ious image after la"eling.
#am"ar ilustrasi yang mewakili "agian !& di gam"ar se"elumnya setelah
la"el.
< !.=S) >9+"=> ? < !.=S) >9+"=> ?
1llustrati,e image representing the !& section in the pre,ious image after la"eling.
#am"ar ilustrasi yang mewakili "agian !& di gam"ar se"elumnya setelah
la"el.
Recent studies Studi "aru-"aru ini
Sakuraba et al assessed the fre:uency of tuberculous pleurisy in patients #ith pleural
effusions containing @0 9-/. or less of adenosine deaminase (%"%) and #ith no pre&ious
diagnosis of Mycobacterium tuberculosis or carcinomatous pleurisy. Sakuraba dkk dinilai
frekuensi birsam T4 pada pasien dengan efusi pleura mengandung @0 9- / . atau kurang
dari deaminase adenosine (%"%) dan tanpa diagnosis sebelumnya Mycobacterium
tuberculosis atau radang selaput dada carcinomatous. =ut of @0 patients #ith %"%
concentrations belo# @0 9-/., the authors found that 2 indi&iduals (ABC) ,follo#ing
biopsy, had been diagnosed #ith tuberculous pleurisy, including D patients #ith %"%
le&els at or belo# D@ 9-/.. "ari @0 pasien dengan konsentrasi %"% di ba#ah @0 9- / .,
penulis menemukan bah#a 2 orang (ABC), berikut biopsi, telah didiagnosa menderita
radang selaput dada T4, termasuk D pasien dengan tingkat %"% pada atau di ba#ah D@
9- / .. Sakuraba et al concluded that occult tuberculous pleurisy e'ists #ith significant
fre:uency in patients #ith pleural effusion %"% concentrations of @0 9-/. or less.
A

Sakuraba dkk menyimpulkan bah#a T4 birsam gaib ada dengan frekuensi yang
signifikan pada pasien dengan konsentrasi %"% efusi pleura sebesar @0 9- / . atau
kurang.
A

9n a retrospecti&e study, =;yurtkan et al sought to determine #hich factors are indicati&e
of early mortality (#ithin D months) in patients #ith malignant pleural effusion. "alam
sebuah penelitian retrospektif, =;yurtkan dkk berusaha untuk menentukan faktor adalah
indikasi dari kematian dini (dalam #aktu D bulan) pada pasien dengan efusi pleura ganas.
Through multi&ariate analysis of data from 1@ patients #ith malignant pleural effusion,
E0 of #hom had suffered early mortality, the authors concluded that predicti&e factors
include high-risk tumors (lesions in the lung, stomach, soft tissue, bladder, esophagus,
prostate, and cer&i', as #ell as lymphoma), lo#er le&els of pleural fluid glucose, and a
poor *arnofsky performance score.
B
8elalui analisis multi&ariat data dari 1@ pasien
dengan efusi pleura ganas, E0 di antaranya menderita kematian dini, penulis
menyimpulkan bah#a faktor prediktif tumor termasuk berisiko tinggi (lesi di paru-paru,
lambung, jaringan lunak, kandung kemih, kerongkongan, prostat, dan leher rahim serta
limfoma,), tingkat yang lebih rendah glukosa cairan pleura, dan skor *arnofsky kinerja
yang buruk.
B

Pathophysiology Patofisiologi
% small amount of fluid is normally present in the pleural space. Sejumlah kecil cairan
biasanya hadir di ruang pleura. The parietal pleura continuously produce the fluid, #hich
is absorbed by the &isceral pleura and by the lymphatics of the parietal pleura. Pleura
parietalis terus memproduksi cairan, yang diserap oleh pleura &isceral dan oleh limfatik
pleura parietalis. The hydrostatic, colloid osmotic, and tissue pressures affect circulation
of the fluid. 9tu, hidrostatik osmotik koloid, dan tekanan jaringan mempengaruhi sirkulasi
fluida. %lteration of A or more of these factors causes abnormal accumulation of fluid in
the pleural space and is the primary mechanism of transudati&e effusions. Perubahan dari
A atau lebih dari faktor-faktor penyebab akumulasi abnormal cairan dalam ruang pleura
dan merupakan mekanisme utama dari efusi transudati&e. 5or instance, increased
hydrostatic pressure and decreased osmotic pressure cause effusions in congesti&e heart
failure ( !,5 ) and nephrotic syndrome, respecti&ely. 8isalnya, meningkatkan tekanan
hidrostatik dan penurunan efusi menyebabkan tekanan osmotik dalam gagal jantung
kongestif ( !,5 ) dan sindrom nefrotik, masing-masing.
9n addition to alteration in the circulation of pleural fluid, injury to the pleura or
subpleural lung parenchyma can cause increased &ascular permeability and a shift of fluid
from the pulmonary interstitium. Selain perubahan dalam sirkulasi cairan pleura, cedera
pada parenkim paru-paru atau pleura subpleural dapat menyebabkan peningkatan
permeabilitas pembuluh darah dan pergeseran cairan dari paru intersititium. This
mechanism is primarily seen in e'udati&e effusions, such as effusion associated #ith
pneumonia and infarction. 8ekanisme ini terutama terlihat pada efusi e'udati&e, seperti
efusi yang berhubungan dengan radang paru-paru dan infark. 9n certain cases, such as
traumatic hemothora' or postsurgical chylothora', the fluid accumulates from leaking
damaged &essels or lymphatic ducts. "alam kasus tertentu, seperti hemothora' traumatis
atau chylothora' pascaoperasi, fluida akumulasi dari kebocoran pembuluh rusak atau
saluran limfatik. 4ecause peritoneal and pleural spaces communicate through defects in
the diaphragm in some patients, peritoneal fluid crosses the diaphragm due to the
negati&e pressure in the pleural ca&ity. *arena ruang peritoneal dan pleura berkomunikasi
melalui cacat diafragma pada beberapa pasien, cairan peritoneal melintasi diafragma
akibat tekanan negatif dalam rongga pleura. ,epatic hydrothora' and pleural effusion
secondary to gynecologic malignancies #ith ascites are B e'amples of this mechanism.
hydrothora' hepatika dan efusi pleura sekunder untuk keganasan ginekologi dengan
asites adalah B contoh mekanisme ini.
Frequency Frekuensi
'nited States 2merika Serikat
4ecause pleural effusion is a manifestation of a #ide spectrum of diseases rather than a
primary entity, its e'act incidence is not kno#n. *arena efusi pleura merupakan
manifestasi dari spektrum yang luas daripada penyakit badan utama, kejadian yang tepat
tidak diketahui. 9n addition, pleural effusion can be an intermittent phenomenon in some
case, such as in !,5 . Selain itu, efusi pleura dapat menjadi fenomena intermiten dalam
beberapa kasus, misalnya di !,5 .
%n estimated A million patients de&elop pleural effusion each year. A juta diperkirakan
mengembangkan efusi pleura pasien setiap tahun. 8ost pleural effusions are secondary to
!,5 , malignancy, pneumonia , or pulmonary emboli. *ebanyakan efusi pleura adalah
sekunder untuk !,5 , keganasan, pneumonia , atau emboli paru. %ppro'imately FBC of
patients #ith !,5 #ere found to ha&e effusion at autopsy. Parapneumonic effusions
de&elop in D2-22C of hospitali;ed patients #ith bacterial pneumonia . Sekitar FBC dari
pasien dengan !,5 ditemukan memiliki efusi di otopsi. Parapneumonic efusi
berkembang dalam D2-22C dari pasien yang dira#at dengan pneumonia bakteri . The
incidence of effusion is lo#er in fungal and &iral lung infections than in bacterial
infection (B-GC in Coccidioides immitis infection and F-AGC in &iral pneumonia ).
9nsiden efusi lebih rendah dalam jamur dan &irus infeksi paru-paru dibandingkan dengan
infeksi bakteri (B-GC pada infeksi immitis Coccidioides dan F-AGC pada &irus radang
paru-paru ). %bout A0-@0C of patients #ith pulmonary embolism de&elop pleural
effusion. Sekitar A0-@0C pasien dengan emboli paru berkembang efusi pleura.
The incidence of the effusion &aries from appro'imately G0-A00C after coronary bypass
or heart and/or lung transplantation to A2-DFC in systemic lupus erythematosus , E-B0C
in acute pancreatitis , and @C in rheumatoid arthritis . 9nsiden efusi ber&ariasi dari sekitar
G-A0C setelah bypass koroner atau jantung dan / atau transplantasi paru-paru untuk A2-
DFC dalam lupus eritematosus sistemik , E0-B0C di pankreatitis akut , dan @C pada
rheumatoid arthritis .
1nternational 1nternasional
9n A international epidemiologic study of pleural effusion in a #ell-defined region of
central 4ohemia, the incidence #as 0.DBC. "alam A studi epidemiologi internasional
efusi pleura di daerah yang jelas tentang 4ohemia pusat, kejadian itu 0,DBC. )'trapolated
to the entire population of the former !;echoslo&akia, this rate represents E1,000 cases
annually. "iekstrapolasi untuk seluruh penduduk dari mantan !ekoslo&akia, tingkat ini
merupakan E1.000 kasus per tahun.
Mortality/Morbidity Mortalitas / Morbiditas
8orbidity and mortality are primarily related to the underlying disease. 8orbiditas dan
mortalitas terutama terkait dengan penyakit yang mendasarinya.
"yspnea is the main clinical symptom directly related to pleural effusion.
"yspnea adalah gejala klinis utama yang berkaitan langsung dengan efusi pleura.
The degree of respiratory function compromise is a function of the si;e of the
effusion and the presence of associated lung parenchymal abnormalities. Tingkat
kompromi fungsi pernafasan adalah fungsi dari ukuran efusi dan adanya kelainan
parenkim paru-paru terkait.
9n some cases, the nature of the pleural effusion may affect the course of the
underlying disease. "alam beberapa kasus, sifat efusi pleura dapat mempengaruhi
jalannya penyakit yang mendasarinya. 5or instance, uninfected parapneumonic
effusions spontaneously clear #ithout altering the outcome of the pneumonia,
#hereas effusions that re:uire drainage increase the risk of morbidity and
mortality. 8isalnya, efusi parapneumonic spontan jelas tidak terinfeksi tanpa
mengubah hasil pneumonia, sedangkan efusi yang memerlukan drainase
meningkatkan risiko kesakitan dan kematian. )ffusions can resol&e
spontaneously, or they can resol&e #hen the underlying disease is medically
treated. )fusi dapat mengatasi secara spontan, atau mereka dapat mengatasi ketika
penyakit yang mendasarinya diobati secara medis.
9n general, effusions that resol&e spontaneously in less than B months are caused
by !,5 ( pneumonia ( acute pancreatitis ( lung, heart, or li&er transplant (
pulmonary embolism ( systemic lupus erythematosus ( traumatic chylothora'( or
uremia . Secara umum, efusi yang menyelesaikan secara spontan dalam #aktu
kurang dari B bulan disebabkan oleh !,5 ( pneumonia , pankreatitis akut , paru-
paru, jantung, atau transplantasi hati , emboli paru , lupus eritematosus sistemik (
chylothora' traumatis, atau uremia . )ffusions after coronary artery bypass or
cardiac injury and those related to sarcoid can resol&e in less than B months(
ho#e&er, they can persist up to 2 months. )fusi setelah bypass arteri koroner atau
cedera jantung dan yang terkait dengan sarcoid dapat menyelesaikan dalam #aktu
kurang dari B bulan, namun mereka bisa bertahan sampai dengan 2 bulan.
Tuberculous pleurisy
A
and chronic pancreatitis effusions resol&e in B-2 months.
T4 birsam
A
dan efusi pankreatitis kronis sembuh dalam B-2 bulan. heumatoid
pleurisy and benign asbestos pleural effusions resol&e spontaneously in B-2
months( in some cases, these resol&e in 2 months to A year. birsam heumatoid
dan efusi pleura asbes jinak menyelesaikan secara spontan dalam B-2 bulan,
dalam beberapa kasus, menyelesaikan dalam 2 bulan sampai A tahun. )ffusion,
especially malignant effusion, can rapidly recur after thoracentesis. )fusi, efusi
terutama ganas, cepat dapat kambuh setelah Thoracentesis.
Presentation Presentasi
The pleuritic chest pain associated #ith pleural irritation is locali;ed, sharp, and se&ere.
asa sakit dada berhubung dgn selaput dada berhubungan dengan iritasi pleura
terlokalisir, tajam, dan berat. 9t is e'acerbated by deep inspiration or coughing. ,al ini
diperburuk oleh inspirasi dalam atau batuk. The de&elopment of effusion may relie&e the
pleuritic pain. Pengembangan efusi dapat meringankan rasa sakit berhubung dgn selaput
dada. The mass effect associated #ith large pleural effusions can cause dyspnea.
Pengaruh massa terkait dengan efusi pleura besar dapat menyebabkan dyspnea. 9n cases
of associated lung pathology, small effusions can cause dyspnea. "alam kasus terkait
patologi paru, efusi kecil dapat menyebabkan dyspnea. The clinical history may help in
limiting the differential diagnosis of the underlying etiology. Sejarah klinis dapat
membantu dalam membatasi diagnosis diferensial dari etiologi yang mendasari.
Small effusions might not be detectable on physical e'amination. efusi kecil mungkin
tidak terdeteksi pada pemeriksaan fisik. .arge effusions produce dependent, diminished
breath sounds and dullness to percussion. efusi besar menghasilkan tergantung, suara
napas berkurang dan kebodohan untuk perkusi. Signs of an underlying process, such as
pneumonia or !,5, can be detected on physical e'amination. Tanda-tanda proses yang
mendasari, seperti pneumonia atau !,5, dapat terdeteksi pada pemeriksaan fisik.
Preferred Examination Pemeriksaan yang dipilih
"ifferent imaging modalities can be used to diagnose and manage pleural disease.
modalitas pencitraan yang berbeda dapat digunakan untuk mendiagnosa dan mengelola
penyakit pleura. 5indings on chest radiographs fre:uently confirm the presence of pleural
effusion. Temuan pada radiografi dada sering mengkonfirmasi adanya efusi pleura.
.ateral decubitus projections enhance the sensiti&ity of con&entional radiography.
Proyeksi lateral dekubitus meningkatkan sensiti&itas radiografi kon&ensional.
"epending on the clinical conte't, ultrasonography or !T can be used to confirm a
pleural effusion, especially in cases of loculated pleural effusion, complete opacification
of hemithora', or associated lung parenchymal abnormalities. Tergantung pada konteks
klinis, ultrasonografi atau !T dapat digunakan untuk mengkonfirmasi efusi pleura,
terutama dalam kasus efusi pleura loculated, opacification lengkap hemithora', atau yang
terkait kelainan parenkim paru. -ltrasonography and !T are more accurate than chest
radiography in identifying the underlying etiology. -ltrasonografi dan !T lebih akurat
daripada radiografi dada dalam mengidentifikasi etiologi yang mendasari. 4oth
modalities can depict small effusions not &isuali;ed radiographically. *edua modalitas
dapat menggambarkan efusi kecil tidak di&isualisasikan radiografis. -ltrasonography and
!T are also used to guide inter&entional procedures to manage pleural effusions.
-ltrasonografi dan !T juga digunakan untuk memandu prosedur inter&ensi untuk
mengelola efusi pleura.
89 is sometimes used to e&aluate :uestionable !T findings. 89 kadang-kadang
digunakan untuk menge&aluasi temuan !T dipertanyakan. 89 has been reported to be
more sensiti&e than !T in differentiating benign from malignant causes of effusion. 89
telah dilaporkan kepada lebih sensitif daripada !T dalam membedakan jinak dari
penyebab dari efusi ganas.
Limitations of echniques !eterbatasan eknik
adiographic studies may not help in differentiating parenchymal processes from pleural
processes. studi radiografi tidak dapat membantu dalam membedakan proses parenkim
dari proses pleura. 9n addition, chest radiography is limited in e&aluating the underlying
etiology, as in differentiating benign disease from malignant pleural disease. Selain itu,
radiografi dada terbatas dalam menge&aluasi etiologi yang mendasarinya, seperti dalam
membedakan penyakit jinak dari penyakit pleura ganas.
0ifferential 0iagnoses 0iferensial 0iagnosa
"ther Problems to #e $onsidered Masalah lain yang perlu
dipertimbangkan
)le&ated hemidiaphragm and/or herniation on a chest radiograph Peningkatan
hemidiaphragm dan / atau herniasi pada foto toraks
Pleural thickening and/or fibrothora' on a chest radiograph Penebalan pleura dan / atau
fibrothora' pada foto toraks
Subpleural fat on a chest radiograph Subpleural lemak pada foto toraks
%scites on a !T scan %scites pada !T scan
Subphrenic abscess on a !T scan Subphrenic abses pada !T scan
http://emedicine.medscape.com/article/344456-o,er,iew
http://www.medison.ru/u7i/eho88.htm
Pleural effusions related to lung cancer are :uite common, so itHs time that 9 discussed
this issue. 5irst, a pleural effusion is fluid outside of the lung, and it tends to follo#
gra&ity and pool at the bottom (base) of the lung, primarily along the back. ,ereHs ho# it
appears on a chest '-ray, filling up the bottom of the left side of the chest. The right side,
in contrast, is mostly black, #hich is the #ay lungs should appear on a chest-'-ray (but
not in real life, #e hope).
(click to enlarge)
,o#e&er, pleural effusions can also be loculated, #hich means that they donHt follo#
gra&ity but rather are contained in pockets that are formed from scar tissue, inflammation,
etc. ,ereHs a !T image sho#ing a loculated effusion on the left side, not freely flo#ing
in the chest to follo# gra&ity$
% fe# starting points to make. +ot all pleural effusions in the #orld are from cancer,
and in fact, itHs probably just under half, #ith the balance being from infections and
inflammatory reactions. %mong the appro'imately E@C of effusions that are from
cancer, lung cancer and breast cancer account for about 20C, #ith lung cancer as the
leading cause (a little more than A/D of all malignant, or cancer-related, pleural
effusions). They are important because the presence of cancer in the pleural fluid
indicates systemic/ad&anced disease (although in S!.! the presence of a malignant
effusion on the same side as the primary cancer is sometimes considered limited, and
sometimes e'tensi&e, #ith no clear consensus), and because people can ha&e symptoms
of shortness of breath, cough, and sometimes pain from a pleural effusion, and relie&ing
those symptoms is an important goal in managing lung cancer.
!larifying that a pleural effusion is malignant can be challenging. Sometimes, the
effusion is the first place people look to obtain a diagnosis of lung cancer, but #e kno#
that e&en in patients #ho ultimately are confirmed to ha&e a malignant pleural effusion
(8P)), it can be hard to find cancer cells in the fluid. This is usually done initially #ith a
thoracentesis, #hich is a procedure in #hich a person has a needle inserted bet#een the
ribs in the back, sometimes under ultrasound or !T guidance, in an area #here there is
fluid beneath the skin, and fluid is then remo&ed.

% thoracentesis can be diagnostic, #hich means it is being done to determine the cause of
the fluid, for #hich usually only a syringe of fluid is remo&ed, or it can be a therapeutic
thoracentesis, in #hich the procedure is being done in order to remo&e as much fluid as
possible to relie&e symptoms for a patient, #ith sometimes as much as t#o liters of
effusion fluid being remo&ed.
The likelihood of finding cancer cells in the fluid from an initial thoracentesis is only in
the @0-20C range. 3ou can increase the chance of finding cancer of finding cancer
o&erall by doing a second thoracentesis (or ItapJ), but the likelihood of being successful
the second time around after an initial negati&e tap is lo#er, in the D@-E@C range. So it is
possible to make a diagnosis of an 8P) most but certainly not all of the time after A-B
thoracenteses.
9n cases #here another source of tissue is not readily accessible, or if it is important for
staging purposes to determine #hether the pleural space is in&ol&ed, thoracoscopy, or
video-assisted thoracoscopic surgery (K%TS), can be performed. This in&ol&es using a
sterile tube #ith a light source and camera at the end that can go into the chest ca&ity
through a small incision and get a look at #hat is happening. % surgeon can also take
biopsies of suspicious tissue through the thoracoscope, and if necessary, can cut scar
tissue and perform other manipulations through it. % picture of studding of the pleural
space #ith tumor is sho#n here (co&er the screen and dont enlarge if youHre s:ueamish
L this is a surgery pictureM)$
Thoracoscopy can get a diagnosis more than G@C all the time. %nd #hile K%TS is only a
small, relati&ely minor surgery as far as chest surgery goes, it can still ha&e complications
such as bleeding, infection, or pain, usually in NA0C of cases, and there are rare deaths
(NBC). The K%TS procedure, but the #ay, is the same general approach that is
sometimes used to perform a lobectomy by specially trained thoracic surgeons, and that's
a topic 9'll discuss separately in the near future.
=nce you ha&e a diagnosis, managing the fluid buildup is another major issue to tackle.
5or some responsi&e cancers, such as lymphomas and S!.!, systemic therapy (such as
chemo) is often enough to also treat the effusion. Some breast cancers, and also some
+S!.!s as #ell, may be responsi&e enough to systemic therapy to not re:uire additional
inter&entions. ,o#e&er, many 8P)s continue to recur and ha&e significant symptoms
associated #ith them. 9Hll discuss the more common #ays to drain and manage the fluid
collections ne't.

posted by "r. >est O D$D0 am link to this post
%& 'esponses to ()ntroduction to Pleural Effusions*
Pages$ P D B 98: Sho# %ll
A. A0
carolyn hodges Says$
Qune AGth, B00F at AB$A@ pm
9H&e left my history before, but #ii repeat.
+S!.! in "ec 0@, F #ks of #kly carboplatin R ta'otere plus daily radiation.
%dditional
chem R cancer free in %pril 02. DD #kly
pleural effusions #/AB00cc to A@00 cc. ,a&e
family doctor, oncologist, cardiologist, pul-
monary doctor R D radiologist. Some recommend pleurodesis R others say no.
8y
fluid R blood tests, 6-rays, !-T scan R Pet
scan all sho# negati&e for cancer.Some doctors think the fluid comes from cancer,
but most think it is damage from radiation.
>ould like your opinion R a discussion of
the effects if surgery is not successful. 9f
successful, #here does the fluid go if the pleural sac is closed off. ThanksM
B. G
Dr. West Says$
8ay A@th, B00F at E$EB pm
9 belie&e that #hat theyHre saying is that there isnHt just a free, open space #here
the fluid is collecting, but rather that there are loculated pockets of fluid that are
not communicating #ith each other (closed off from each other). % Pleur' catheter
can sometimes be used, but itHs a harder situation to manage than ha&ing one big
open space #ith fluid in it.
-"r. >est
D. 1
Jill E Says$
8ay AEth, B00F at G$D2 pm
"r. >est, >hat is meant by comple' fluids in respect to pleural effusions. 8y
mom is e'periencing shortness of breath during her second line treatment for lung
cancer (actually 8!-P). She had a small amount of fluid drained last #eek. The
medical staff told us that they couldnHt drain any more fluid because it #as
comple' fluids.She continues to be short of breath. ,er regular oncologist is out
for a fe# days. %e there other methods for remo&ing comple' fluidsS Thanks
again for your time.
Qill
E. F
Dr West Says$
8arch A1th, B00F at 1$@E pm
3es, it #ould be concerning to see fluid that #as &ery bloody (brighter red), but
#e typically see something in the range of #hat youHre describing, or sometimes
#ithout the rust, more of a clear or cloudy stra#-colored fluid.
@. 2
sdp131 Says$
8arch A1th, B00F at E$@D pm
"r. >est,
8y partner had a Pleur' catheter inserted @ days ago, after ha&ing a thoracentesis
about E #eeks prior for his 8P). The fluid is a rusty tea color. 9s that color of
fluid to be e'pectedS
8any thanks for this site, and the time you de&ote to it.
2. @
Dr West Says$
8arch A1th, B00F at E$0D pm
3es, pleurodesis can be helpful, but it can also ha&e complication. 9Hll go o&er
some of these issues in my ne't post.
-"r. >est
F. E
hubbie Says$
8arch AFth, B00F at A$0F pm
8y #ife had thoracentesis t#ice and then pleurodesis. 4efore the second
thoracentesis she had a clean pet/ct (after radiation #ith ta'otere)but the fluid
tested positi&e for cancer cells. Qust before the pleurodesis she had another ct scan
to check for measurable disease to see if she #as eligible for a trial as #e agreed
#ith the doctor she should ha&e treatment considering the recurrent malignant
pleural effusion. 9t surprised us that #ith nothing on the last petscan and a &ery
recent ct scan #ith no measurable disease she still had a fast refilling effusion that
necessitated pleurodesis. Pleurodesis #as much more of an ordeal than #e
e'pected(1 days in the hospital as line clogged up unkno#n to anyone and second
chest tube installed) and reco&ery took t#o #eeks at home.
1. D
Dr West Says$
8arch AFth, B00F at AA$BE am
Thank you both for your ongoing interest. egarding .isaHs :uestions, 9 donHt
think blood#ork #ould be &ery reliably to rule in or rule out infection. %nd yes,
#hile 9 #ould e'pect that inflammation follo#ing radiation #ouldnHt be likely to
appear BT years later, but especially #ith a minimal effusion, 9 think it still sounds
fairly ambiguous. 4esides, sheHs no# on treatment, so it sounds like sheHs not
getting a pat on the back and being told not to #orry it (that may be partly in
deference to your desire to be proacti&e). %ll in all, 9Hd say itHs certainly
concerning, but the fact that she #ent a full t#o years #ithout progression
suggests to me that the o&erall pace of the disease may &ery #ell continue to be
far slo#er than the general statistics.
9Hll just add that as !han#it suggested, using symptoms related to a kno#n pleural
effusion, such as dyspnea, and the inter&al that a patient can go bet#een taps for
fluid remo&al, probably do pro&ide a reasonable guide to #hat the disease is
doing.
G. B
!isa "mith Says$
8arch AFth, B00F at 1$AF am
9nteresting article. 9Hm glad you touched on this subject. 8omHs latest !T just
sho#ed minimal pleural effusion. They are #atching it. 9Hm not as laid back as the
docs appear to be. Uuestion$ 9f it #as due to infection, #ouldnHt that be indicated
some#here in her blood #ork. %lso, she hasnHt undergone radiation in B.@ years,
so can #e rule out inflammation. 8ore like than not, that #ould lea&e the effusion
directly related to progression of cancer, correctS "onHt you think itHs probably
time that this nasty disease has #oken up and is starting to do its final dance. She
is on %limta after a t#o year progression free period. Still termed local
recurrence. Tarce&a didnHt #ork. %limta #as started a couple of months ago.
=n behalf of e&eryone, thank you again for your efforts.
A0. A
Chan#it Says$
8arch AFth, B00F at F$@G am
This post takes me back to 5eb. B002 #hen my #ife #as "6 in hospital #ith
+S!.! #ith pleural effusion. The first oncology jargon 9 heard #as Idetermine
the primary source of the cancerJ since it #as metastatic. The resident hospital
pulmonary doctor seem reluctant at first to perform the thoracentesis but it #as
done (not as :uickly as the oncologist recommended). !larifying that the pleural
effusion #as malignant #as challenging as you hinted. The stains #ere
!ytokeratin F R B0 strongly positi&e but the TT5-A, &illin, >T-A #ere negati&e.
The impression #as that the origin of the tumor remained unclear. That being
done along #ith !T and 89 scans, presented her #ith the +S!.! d'. The initial
color of the effusion #as a fairly clear yello#ish li:uid. 8onths #ent by before
additional effusion de&eloped and #ith those taps the fluid had changed to a tea
colored fluid. (comments). ,er S=4 and irregular breathing #as ho# 9 judged
that the effusion #as recurring #hich prompted immediate doctor attention and
e&entual pleurodesis. 9n summary, if 9 had not detected the pleural effusion
symptoms and had her treated, she #ould not ha&e li&ed to recei&e Tarce&a #hich
#as the drug designed #ith her genes in mind.
"r. >est, thanks for this information.
!han#it
http$//onctalk.com/B00F/0D/AF/intro-to-pleural-effusions/
ABSTRAK
The pleural effusion, formerly called pleural spill, is anaccumulation of fluid in the
pleural space, as a consequence ofan imbalance between the formation and
reabsorption of suchfluid, or due to an alteration in the drainage to lymph nodes.The
purpose of this bibliographic review is to establish theimportance of the use of
ultrasound in pleural diffusiondiagnosis. The efusi pleura, sebelumnya disebut
tumpah pleura, adalah anaccumulation cairan dalam ruang pleura, sebagai
konsekuensi ofan ketidakseimbangan antara pembentukan dan reabsorpsi suchfluid,
atau karena adanya perubahan dalam drainase untuk tujuan nodes.The getah bening
dari tinjauan ini adalah bibliografi untuk mendirikan theimportance penggunaan USG
dalam diffusiondiagnosis pleura. The authors discuss the use of ultrasonography in
thediagnosis and therapeutic approach of this disease, and stressthe importance of
ultrasonography in chest diseases diagnosis,its advantages, limitations and
disadvantages when compared tothe common !ray, computed tomography and
physical eamination.The authors also discuss the definition of pleural effusion,
itsphysiopathology, morbidity, mortality, main causes and clinicalpresentation. "ara
penulis membahas penggunaan ultrasonografi dalam thediagnosis dan pendekatan
terapi penyakit ini, dan pentingnya stressthe pemeriksaan ultrasonografi dalam
diagnosis penyakit dada, kelebihan, keterbatasan dan kelemahan bila dibandingkan
umum tertalu !ray, computed tomography eamination.The fisik dan penulis juga
membahas definisi efusi pleura, itsphysiopathology, morbiditas, mortalitas, penyebab
utama dan clinicalpresentation. The eamination technique is
systematicallyapproached both by thoracic and abdominal pathways. Teknik ujian
systematicallyapproached baik oleh dan perut jalur toraks.
Keywords: "leural effusion# "leural spill# Ultrasound. Kata kunci: efusi pleura#
tumpah pleura# USG.
INTRODUCTION PENDAHUUAN
$or some time one thought that ultrasound could not be used inchest assessment.
Untuk beberapa satu kali berpikir USG yang tidak dapat digunakan mengepak dlm
peti penilaian. The main chest organs are filled with air whichis not a good ultrasound
conductor. %rgan dada utama dipenuhi dengan udara bukan konduktor whichis USG
baik. &esides that, the ribs blockultrasound. Selain itu, blockultrasound rusuk.
'owever, ultrasound has become an invaluable resourcein the assessment of
abnormal chest, in which liquid and soliddensities are interposed between the chest
wall and the lungs,allowing ecellent propagation of sound waves, making it
possibleto etend the use of ultrasound in the diagnosis of a number ofmorbidities
!"#
. (amun, USG telah menjadi resourcein berharga penilaian dada yang tidak normal,
di mana cair dan soliddensities adalah sela antara dinding dada dan paru!paru, yang
memungkinkan baik propagasi gelombang suara, sehingga possibleto
memperpanjang penggunaan USG dalam diagnosis nomor ofmorbidities
!"#$

Ultrasonography can be used to clarify the nature of pleural densities, pleural
effusions and pleural thickening. Ultrasonografi dapat digunakan untuk menjelaskan
sifat kerapatan pleura, efusi pleural dan penebalan pleura. )t can also differentiate
pleural from parenchymal lesions, visuali*e ill parenchyma obscured by pleural
effusion and detect pleural septations and other pleural abnormalities. 'al ini juga
dapat membedakan pleura dari lesi parenkim, parenkim memvisualisasikan sakit
tertutup oleh efusi pleura dan mendeteksi septations pleura pleura dan kelainan
lainnya. )t makes the differential diagnosis of pulmonary parenchyma diseases like
consolidation, atelectasis and tumor. 'al ini membuat diagnosis diferensial penyakit
parenkim paru seperti konsolidasi, atelektasis dan tumor. )t differentiates cystic
tumor masses from the solid ones# tumor or large or persistent pleural effusion#
clarifies subpulmonary or subphrenic fluid cases, chest wall tumor mass or pleural
fluid + $igure , -. )ni membedakan massa tumor kistik dari yang padat# tumor atau
efusi pleura besar atau terus!menerus# mengklarifikasi kasus subphrenic cairan atau
subpulmonary, tumor dinding dada massa atau cairan pleura + Gambar , -. )t
identifies the cause of unilateral elevation of the diaphragm and alteration of its
motility, which can be caused by phrenic nerve paralysis, subpulmonary pleural
effusion + $igure . -, subphrenic abscess, mass in the superior abdomen,
diaphragmatic hernia, diaphragmatic tumor, and pulmonary volume reduction. )ni
mengidentifikasi penyebab elevasi diafragma unilateral dan perubahan motilitas,
yang dapat disebabkan oleh kelumpuhan saraf frenikus, efusi pleura subpulmonary +
Gambar . -, abses subphrenic, massa di perut unggul, hernia diafragma, tumor
diafragma, dan paru pengurangan volume. )t allows the visuali*ation of mediastinal
tumor masses, the relationship of the masses with the thymus and etension of
cervical masses to the chest. 'al ini memungkinkan visualisasi massa tumor
mediastinum, hubungan antara massa dengan timus dan perluasan massa serviks di
dada. )t identifies the position of catheters in vessels. )ni mengidentifikasi posisi
kateter di pembuluh. )t diagnoses pericardial spills and identifies vascular thrombi
+for eample/ cardiac thrombi in superior and inferior vena cava-. )ni diagnosa
tumpahan perikardial dan mengidentifikasi thrombi vaskular +misalnya/ thrombi
jantung di superior dan inferior vena cava-. )t can identify pneumothora. 'al ini
dapat mengidentifikasi pneumotoraks. &esides establishing diagnosis, ultrasound can
be used to guide thoracentesis + $igure 0 -, needle biopsies of peripheral and
mediastinal tumor masses, and the placement of endotracheal probes
!%#
. Selain
menetapkan diagnosis, USG dapat digunakan untuk memandu Thoracentesis +
Gambar 0 -, jarum biopsi dari massa tumor mediastinum dan perifer, dan
penempatan probe endotrakeal
!%#$

1ntara berbagai indikasi dan penggunaan chestultrasound itu, tujuan dari penelitian
ini adalah meninjau inthe perannya efusi pleura.
PEURA E&&USION E'usi ()eura
The pleural effusion occurs due to the accumulation of fluidin the pleural space as a
consequence of an imbalance between theformation and fluid absorption or due to
alteration in thedrainage to lymph nodes. The efusi pleura terjadi karena akumulasi
fluidin ruang pleura sebagai konsekuensi dari ketidakseimbangan antara
theformation dan penyerapan cairan atau karena perubahan dalam thedrainage ke
kelenjar getah bening. There are two types of pleuraleffusion
!*#
/ 1da dua jenis
pleuraleffusion
!*#:

, 2 Transudate/ )t occurs when there is an increase ofhydrostatic pressure or a
decrease of capillary oncotic pressure.1s eamples, one can name congestive heart
failure, cirrhosis,nephrotic syndrome, peritoneal dyalisis, superior vena
cavaobstruction, glomerulonephritis, miedema, pulmonary embolism,sarcoidosis
and hypoalbuminemia. , ! Transudate/ 'al ini terjadi ketika terjadi peningkatan
tekanan ofhydrostatic atau penurunan kapiler oncotic pressure.1s contoh, kita dapat
menyebutkan gagal jantung kongestif, sirosis, sindroma nefrotik, dyalisis peritoneal,
cavaobstruction kava superior, glomerulonefritis, miedema, emboli paru, sarcoidosis
dan hipoalbuminemia.
. 2 3sudate/ )t occurs due to the increase in permeability inmicrocirculation or
alteration in the pleural space drainage tolymph nodes. . ! 3sudate/ )ni terjadi
karena peningkatan permeabilitas inmicrocirculation atau perubahan pada node
tolymph drainase rongga pleura. 1s eamples, one can point infectious
diseases,neoplastic diseases, collagen!vascular diseases, drug!induceddiseases,
gastrointestinal diseases, hemothora, chylothora andmiscellaneous +4eigs5
syndrome, asbestosis, uremia, urinary tractobstruction, adult respiratory distress
syndrome, abdominalsurgery, yellow nail syndrome-
!*#
. Sebagai contoh, seseorang
dapat titik penyakit menular, penyakit neoplastik, penyakit vaskular!kolagen, obat!
induceddiseases, penyakit gastrointestinal, hemothora, chylothora
andmiscellaneous +5sindrom 4eigs, asbestosis, uremia, tractobstruction kemih,
sindrom distress pernapasan dewasa, abdominalsurgery, sindrom kuku kuning
# !*#$

6i 1merika Serikat efusi pleura mempengaruhi individu ,.0million setiap tahun. The
main diseases that triggerthis comorbidity are heart failure decompensation
+788,888-,bacterial pneumonia +088,888-, malignancy +.88,888-, pulmonaryemboli
+,78,888-, cirrhosis with ascites +78,888-, pancreatitis+.8,888-, collagenosis and
vasculitis +9,888- and tuberculosis+.,788-. "enyakit yang utama adalah triggerthis
komorbiditas gagal jantung dekompensasi +788.888-, pneumonia bakteri +088.888-,
keganasan +.88.888-, pulmonaryemboli +,78.888-, sirosis dengan asites +78.888-,
pankreatitis +.8.888-, collagenosis dan vaskulitis +9.888- dan T&: +..788-. %n the
other hand, in &ra*il the percentage of pleuraleffusion associated to tuberculosis
isgreater
!+#
. 6i sisi lain, di &ra*il persentase pleuraleffusion terkait untuk isgreater
tuberkulosis
!+#$

The pleural effusion morbidity and mortality are directlyrelated to its causes, the
stage of the disease at the time ofthe diagnosis, and to the pleural fluid biochemical
finding. 3fusi pleura morbiditas dan kematian yang directlyrelated untuk
penyebabnya, tahap penyakit tersebut pada waktu tersebut yang diagnosis, dan ke
biokimia menemukan cairan pleura. Themorbidity and mortality rates of patients with
pneumoniaassociated with pleural effusion are greater than in patientswith
pneumonia alone. Themorbidity dan tingkat kematian pasien dengan efusi pleura
pneumoniaassociated dengan lebih besar daripada pneumonia patientswith sendirian.
The development of malignant pleuraleffusion is associated with a poor prognosis.
"engembangan pleuraleffusion ganas dikaitkan dengan prognosis yang buruk. The
life epectancyof pleural effusion with a malignant etiology is from three tosi
months. The epectancyof kehidupan efusi pleura dengan etiologi ganas dari tiga
bulan tosi. "atients with pleural effusion associated with lungcarcinoma and
gastrointestinal tract carcinoma have a reducedlife epectancy. "asien dengan efusi
pleura yang terkait dengan lungcarcinoma dan karsinoma saluran pencernaan
memiliki harapan reducedlife. There is significant association of malignantpleural
effusion with breast and gynecologicmalignancies
!*#
. 1da hubungan yang signifikan
dari efusi malignantpleural dengan payudara dan gynecologicmalignancies
!*#$

The more commonly associated clinical manifestations areprogressive dyspnea, non!
productive cough and pleuritic pain.6yspnea is the most usual finding, generally
indicative of largeeffusions, although not superior to 788 ml. 4anifestasi klinis yang
terkait umumnya lebih areprogressive dispnea, batuk non!produktif dan
pain.6yspnea berhubung dgn selaput dada adalah menemukan yang paling biasa,
umumnya menunjukkan largeeffusions, meskipun tidak sampai 788 ml unggul. The
physicaleamination is generally normal when there is less than 088 ml ofliquid/ in
larger quantities, one observes massiveness, reducedvesicular murmur, decreased
vocal fremitus and thoracicepansibility
!*#
. physicaleamination pada umumnya
normal ketika ada kurang dari 088 ml ofliquid/ dalam jumlah yang lebih besar,
diamati sifat besar!besaran, murmur reducedvesicular, penurunan fremitus vokal dan
thoracicepansibility
!*#$

There are four main types of fluids in the pleural space/serous +hydrothora-, blood
+hemothora-, lymph +chylothora- andpurulent +pyothora or empyema-. 1da
empat jenis utama cairan di ruang pleura/ serosa +hydrothora-, darah
+hemothora-, getah bening +chylothora- andpurulent +pyothora atau empiema-.
AD,ANTA-ES O& THE UTRASOUND IN THE PEURA
E&&USIONDIA-NOSIS KEUNTUN-AN US- DAA.
E&&USIONDIA-NOSIS ()eura)
;hen the ultrasound is used for the analysis and quantification of fluids in pleural
effusion, it is superior to chest !rays, being capable of correlating the effusion
thickness with the real volume
!+/0#
+ $igure . -. <etika USG digunakan untuk analisis
dan kuantifikasi cairan di efusi pleura, lebih unggul daripada !ray dada, yang
mampu menghubungkan ketebalan efusi dengan volume riil
!+/0#
+ Gambar . -. )t
allows the detection of small amounts of pleural locular fluid, with positive
identification of amounts as small as 0 to 7 ml, that cannot be identified by !rays as
it is only capable of detecting volumes above 78 ml of liquid
!1#
. 'al ini
memungkinkan deteksi sejumlah kecil cairan locular pleura, dengan identifikasi
positif dalam jumlah kecil seperti 0!7 ml, yang tidak dapat diidentifikasi oleh !sinar
karena hanya mampu mendeteksi volume di atas 78 ml cairan
!1#$
:ontrary to the
radiological method, ultrasound allows an easy differentiation of pleural locular liquid
and thickened pleura + $igure 0 -. &erlawanan dengan metode radiologi, USG
memungkinkan diferensiasi mudah menebal pleura locular cair dan pleura + Gambar
0 -. )t is efficient in pinpointing thoracocentesis, even in small fluid collections
!1/2#
.
'al ini menunjukkan dengan tepat thoracocentesis efisien, bahkan di koleksi fluida
kecil
!1/2#$
The risks in resourcing only to physical eamination without ultrasound
guidance for puncture include/ pneumothora, hemothora, subdiaphragmatic
hematoma and subdiaphragmatic organs lacerations. =isiko di resourcing hanya
untuk pemeriksaan fisik tanpa bimbingan USG untuk tusuk meliputi/ pneumotoraks,
hemothora, hematoma organ subdiaphragmatic dan subdiaphragmatic lecet. The
use of Ultrasonography is a very promising solution for the reduction of those
possible complications
!3#
. "enggunaan Ultrasonografi adalah solusi yang sangat
menjanjikan untuk penurunan komplikasi yang mungkin
!3#$

;hen compared to computed tomography +:T-, ultrasound detects the inverted
diaphragm in longitudinal or sagitally oriented studies, which is not possible with :T,
ecept for reconstruction. &ila dibandingkan dengan computed tomography +:T-,
USG mendeteksi diafragma atau terbalik dalam sagitally berorientasi studi
longitudinal, yang tidak mungkin dengan :T, kecuali untuk rekonstruksi. Ultrasound
has the advantage of being a portable and practical technique, which makes it very
useful in the study of infants in critical condition, whose pulmonary opacities may be
mistakenly taken as pleural effusions + $igure > -
!"#
. USG memiliki keuntungan dan
praktis menjadi teknik portabel, yang membuatnya sangat berguna dalam studi bayi
dalam kondisi kritis, yang paru kekeruhan mungkin keliru dianggap sebagai efusi
pleura + Gambar > -
!"#$
The :T scan is not always an available resource, and it is
epensive when compared to ultrasound, and at pediatric age range :T requires
patients5 sedation
!2/"4#
. :T scan tidak selalu merupakan sumber daya yang tersedia,
dan mahal jika dibandingkan dengan ultrasound, dan pada rentang usia :T pediatrik
membutuhkan 5sedasi pasien
!2/"4#$

Kekuran5an US- DAA. e'usi ()eura
1 limitation of chest ultrasound is revealed when veryhomogeneous and solid lesions
may appear as cystic lesions. Sebuah keterbatasan USG dada ini terungkap saat dan
padat lesi veryhomogeneous mungkin muncul sebagai lesi kistik. )nthe chest, there
is no solid or cystic structure that may serveas a reference to allow such
differentiation. inthe dada, tidak ada struktur padat atau kistik yang mungkin
serveas referensi untuk memungkinkan diferensiasi tersebut. 1nother difficultywith
ultrasound assessment of the chest is the acoustic shadecaused by a dense rib,
which may induce an inattentive observerto believe that a tumor mass is anechoic.
USG penilaian lain difficultywith dada adalah akustik shadecaused oleh tulang rusuk
padat, yang dapat menyebabkan sebuah observerto lalai percaya bahwa massa
tumor anechoic. 1dditionally thedifferentiation between hemothora and pleural
effusion isdifficult, ecept when the patient clinical history isavailable
!"#
. Selain
thedifferentiation antara hemothora dan isdifficult efusi pleura, kecuali ketika
sejarah klinis pasien isavailable
!"#$

CHEST UTRASOUND E6A.INATION TECHNI7UE TEKNIK
PE.ERIKSAAN US- DADA
The patient may be in a sitting position or in supine position. "asien mungkin berada
dalam posisi duduk atau dalam posisi telentang. The pleural space is superficial and
promptly eamined by ultrasound, both via direct intercostal and abdominal
approaches. =uang pleura adalah dangkal dan segera diperiksa oleh USG, baik
melalui pendekatan interkostalis dan perut langsung. 1 high frequency linear
transducer +7 to ?.7 4'*- applied directly to the chest or a sectorial or conve
transducer +0.7 to 7 4'*- conducted superiorly from abdomen provides a view of the
pleural space
!"/+#
+ $igure 9 -. $rekuensi yang tinggi transduser linier +7!?,7 4'*-
diterapkan secara langsung ke dada atau atau cembung transduser sektoral +0,7!7
4'*- dilakukan superior dari perut memberikan pandangan dari ruang pleura
!"/+#
+
Gambar 9 -.
Pendekatan )an5sun5 interkosta)is ! =uang pleura adalah pada kedalaman , cm
dari antarmuka tulang rusuk. The air!filled lung, covered by the visceral pleura, is a
powerful reflector of the ultrasound beam, blocking a deeper penetration of
ultrasound into the chest, producing a bright linear interface that moves with
respiration. The!paru penuh udara, dilindungi oleh pleura visceral, adalah reflektor
kuat dari balok USG, menghalangi penetrasi yang lebih dalam dari USG ke dada,
menghasilkan antarmuka linier terang yang bergerak dengan respirasi. The bright
linear interface is the visceral pleura ultrasonographic marker. 1ntarmuka linier
terang adalah penanda visceral pleura ultrasonografi. (ormally, there is a thin and
dark line of pleural fluid separating the parietal pleura from the visceral pleura.
&iasanya, ada gelap dan garis tipis cairan pleura pleura parietalis memisahkan dari
pleura visceral. The parietal pleura is seen as a thin echogenic line, less distinct, in
general obscured by reverberation effect. "leura parietalis dipandang sebagai garis
echogenic tipis, kurang jelas, pada umumnya tertutup oleh efek gema. )ts location is
inferred based on its relationship with the ribs and the visceral pleura. @okasinya
6iduga berdasarkan hubungannya dengan iga dan visceral pleura. The pleural fluid,
in its greater part, is relatively anechoic and easily recogni*ed as an area of
echolucency separating the parietal pleura from the visceral pleura
!"/+#
. :airan
pleura, dalam bagian yang lebih besar, relatif anechoic dan mudah diakui sebagai
daerah echolucency memisahkan pleura parietalis dari pleura viseral
!"/+#$

A8do9ina) a((roac: 2 ;hen an image is obtained from the abdomen, the
diaphragm appears as a bright and curved echogenic line, that moves with
respiration. Pendekatan Perut ! <etika gambar diperoleh dari perut, diafragma
muncul sebagai garis melengkung echogenic dan terang, yang bergerak dengan
respirasi. The normal diaphragm is 7mm thick and is covered by parietal pleura in its
thoracic face and by the peritoneum in its abdominal face. 6iafragma normal adalah
7mm tebal dan ditutupi oleh pleura parietal di wajah dan dada oleh peritoneum di
wajah perut nya. The lung acts as a specular reflector +similar to a mirror-. paru!paru
bertindak sebagai reflektor specular +mirip dengan cermin-. 1 specular reflection of
the liver and of the spleen is seen above the diaphragm, and this sign is a definite
evidence of pleural fluid absence above the diaphragm. Sebuah refleksi specular hati
dan limpa terlihat di atas diafragma, dan tanda ini merupakan bukti yang pasti dari
tidak adanya cairan pleura di atas diafragma. The signs of pleural effusion in an
abdominal approach include anechoic fluid below the diaphragm, visuali*ation of the
chest cavity through the fluid accumulation, liver and spleen specular reflection
absence above diaphragm and in large effusions
!"/+#
. Tanda!tanda efusi pleura
dalam pendekatan perut termasuk cairan anechoic di bawah diafragma, visualisasi
rongga dada melalui akumulasi cairan, hati dan limpa tidak adanya refleksi specular
di atas diafragma dan di efusi besar
!"/+#$

UTRASONO-RAPHIC SI-NS O& PEURA E&&USION TANDA;
TANDA u)trasono5ra'i e'usi ()eura
The ultrasonographic signs of pleural effusion include thedetection of an anechoic
space immediately deep to the thoracicwalls. Tanda!tanda ultrasonografi efusi pleura
termasuk thedetection dari ruang anechoic segera mendalam ke thoracicwalls. 1s the
pleural effusions are sound conducting, deeplysituated structures in relation to the
effusions which are notnormally visible, become visible when such a condition
ispresent. Sebagai efusi pleura adalah melakukan suara, struktur deeplysituated
sehubungan dengan efusi yang notnormally terlihat, menjadi terlihat saat kondisi
seperti ispresent. (ormally, when eamining the thoracic wall thorough theliver,
nothing is visible through it as the aerated lunginterrupts the ultrasound beam.
&iasanya, saat memeriksa dinding toraks theliver menyeluruh, tidak ada yang
terlihat lewat itu sebagai lunginterrupts soda balok USG. 'owever, in the presence
ofpleural effusion, the posterior thoracic wall becomesvisible
!"/%/+#
. (amun, di
hadapan efusi ofpleural, dinding toraks posterior becomesvisible
!"/%/+#$

1 pleural effusion appears as a hypoechoic collection immediately above diaphragm
and adjacent structures. Sebuah efusi pleura muncul sebagai kumpulan hypoechoic
tepat di atas diafragma dan struktur berdekatan. %ne can separate the subjacent
consolidated lung from the effusion, because the pulmonary consolidation is more
dense and contains multiple aerial echogenic areas +air bronchograms- in its interior.
Satu dapat memisahkan paru konsolidasi dari efusi yg terletak di bawah, karena
konsolidasi paru lebih padat dan berisi udara echogenic beberapa daerah
+bronchograms udara- di interior. 1 non!complicated effusion is totally anechoic,
while a comple collection such as hemothora or empyema has a thicker fluid with
septations + $igure 7 -
!"/""#
. 1!rumit efusi non sepenuhnya anechoic, sementara
koleksi yang kompleks seperti hemothora atau empiema memiliki cairan kental
dengan septations + Gambar 7 -
!"/""#$

The free fluid flows about the pleural space according topatient position. 1liran fluida
bebas tentang ruang pleura menurut topatient posisi. )n dorsal decubitus, the fluid
flows to theback of the liver and the lungs. 6alam dekubitus punggung, aliran fluida
theback dari hati dan paru!paru. )f the patient is standing, thefluid flows between the
lung and thediaphragm
!"#
. Aika pasien berdiri, arus thefluid antara paru!paru dan
thediaphragm
!"#$

There are two findings that have proven to be predictive ofpleural fluid/ the presence
of a definite alteration in the formof a pleural density during inspiration and
epiration, and thepresence of mobile septations within the pleural
lesion."resumably, septations are fibrin bundles. 1da dua temuan yang telah terbukti
cairan ofpleural prediksi/ adanya suatu perubahan tertentu dalam formof kepadatan
pleura pada inspirasi dan kedaluwarsa, dan thepresence dari septations mobile dalam
pleura yang lesion."resumably, septations adalah kumpulan fibrin. The back and
forthmovement is unequivocal evidence that the fluid has a relativelylow viscosity
!"/""#
. &agian belakang dan forthmovement adalah bukti tegas bahwa fluida yang
memiliki viskositas relativelylow
!"/""#$

6oppler can also be helpful in distinguishing a pleuraleffusion from a pleural
thickening. 6oppler juga dapat membantu dalam membedakan pleuraleffusion dari
sebuah penebalan pleura. ;hen a free pleural effusionis present, there is a colored
sign between the visceral andparietal pleurae or near the costophrenic angle which is
relatedwith the respiratory movements. <etika effusionis pleura bebas sekarang, ada
tanda berwarna antara pleurae andparietal mendalam atau dekat sudut kostofrenikus
yang relatedwith gerakan pernafasan. 1n organi*ed pleural thickeningappears like
pleural lesion with no 6opplersignals
!"#
. Sebuah pleura thickeningappears
terorganisir seperti lesi pleura tanpa 6opplersignals
!"#$

Dia(:ra59 si5n < ;hen liver or spleen are used as acoustic windows and a fluid is
seen adjacent to these organs, the location of the fluid is determined by reference to
the position of the diaphragm. Dia'ra59a tanda ; <etika hati atau limpa digunakan
sebagai jendela akustik dan fluida dipandang berdekatan dengan organ!organ, lokasi
fluida ditentukan dengan mengacu pada posisi diafragma. )f the fluid is inside the
diaphragm and centrally positioned this fluid is ascites. Aika fluida berada di dalam
posisi sentral diafragma dan cairan ini adalah asites. )f the fluid is outside the
diaphragm and more peripherally located, it is within the pleural space
!"#
. Aika fluida
berada di luar diafragma dan lebih peripherally terletak, adalah dalam ruang pleura
!"#$

Si5n o' t:e dis()aced dia(:ra59atic crus < The fluid is within the pleural space if
there is interposition of fluid between the diaphragmatic crus and the vertebral
column, displacing the crus and increasing its distance to the column
!"#
. Tanda
kruris dia'ra59atik (en5un5si ; fluida adalah dalam ruang pleura jika ada
penempatan fluida antara crus diafragma dan kolom vertebral, menggantikan kruris
dan meningkatkan jarak untuk kolom
!"#$

Si5n o' naked area < The anterior space of the liver right lobe is directly held to
the posterior diaphragm without peritoneum. Si5n wi)aya: te)an=an5 ; =uang
anterior dari lobus kanan hati secara langsung diselenggarakan ke diafragma
posterior tanpa peritoneum. Therefore, the ascetic fluid in the subhepatic or
subphrenic space cannot etend behind the liver up to the level of the naked area
!"#
. %leh karena itu, cairan pertapa dalam ruang subphrenic subhepatic atau tidak
dapat memperpanjang balik hati sampai ke tingkat daerah telanjang
!"#$

APPICATION IN THE 7UANTI&ICATION APIKASI DI ATAS
kuanti'ikasi
The fluid volume can be calculated by measuring the maimum perpendicular
distance between the surface and the chest wall. Bolume cairan dapat dihitung
dengan mengukur jarak tegak lurus maksimum antara permukaan dan dinding dada.
The scan is performed with the patient in the supine position, at maimum
inspiration. 4emindai dilakukan dengan pasien dalam posisi telentang, pada inspirasi
maksimal. The measurement is made right above the diaphragm. "engukuran ini
dibuat tepat di atas diafragma. 1 .8mm etension corresponds to an average volume
of 0C8 ml +D ,08 ml-. Sebuah perpanjangan .8mm sesuai dengan volume rata!rata
0C8 ml +D ,08 ml-. 1 >8 mm etension corresponds to an average volume of ,,888
ml +D 008 ml- as shown on :hart , -
!%/+/0#
. Sebuah ekstensi >8 mm sesuai dengan
volume rata!rata ,.888 ml +D 008 ml- seperti yang ditunjukkan pada &agan , -
!%/+/0#$
1nother way to estimate the pleural effusion is classifying it as minimal, if the
hypoechoic space is seen only at the costophrenic angle# small if it covers the
costophrenic angle but limited within the image formed by the transducer# moderate
if the space is larger than the image but limited within two images# and large or
massive if it is larger than two images formed by the transducer
!>#
. :ara lain untuk
memperkirakan efusi pleura adalah mengelompokkan sebagai minimal, jika ruang
hypoechoic terlihat hanya pada sudut kostofrenikus# kecil jika mencakup sudut
kostofrenikus tetapi terbatas dalam bayangan yang dibentuk oleh transduser# sedang
jika ruang lebih besar daripada gambar tetapi terbatas dalam waktu dua gambar#
dan besar atau besar jika lebih besar dari dua gambar yang dibentuk oleh transduser
!>#$

APIKASI di 8a8ak kua)i'ikasi
The sonographic spectrum of the pleural fluid is useful indifferentiating transudates
from eudates. Spektrum sonographic cairan pleura berguna transudates
indifferentiating dari eksudat. 1nechoic effusionsrepresent transudative processes
and eudative processes withalmost the same frequency. 3ffusionsrepresent
1nechoic proses transudative dan proses eudative withalmost frekuensi yang sama.
'owever the echogenic liquid containsfloating particulate matter, septations or fibrine
filaments# oris associated with pleural nodes# or pleural thickening greaterthan 0 mm
is an eudate. (amun containsfloating echogenic partikulat cair, septations atau
filamen fibrine# oris berhubungan dengan node pleura# atau greaterthan penebalan
pleura 0 mm adalah suatu eksudat. The definite diagnosis is performed bymeans of
analysis of the fluid afterthoracocentesis
!""/"%#
. 6iagnosis pasti dilakukan bymeans
analisis dari afterthoracocentesis fluida
!""/"%#$

PARAPNEU.ONIC E&&USIONS PARAPNEU.ONIC e'usi
The ultrasonography is an ancillary method to infer theanatomopathologic phase of
the pleural disease +parapneumoniceffusion or empyema- and, consequently, it may
be of help in thechoice of suitable treatment. ultrasonografi adalah metode tambahan
untuk menyimpulkan tahap theanatomopathologic penyakit pleura
+parapneumoniceffusion atau empiema- dan, akibatnya, mungkin bisa membantu
dalam thechoice pengobatan yang cocok. The 1merican Thoracic Societyclassifies the
pleural reaction to an infectious process intothree consecutive anatomopathological
phases/ acute or eudativephase# initial, characteri*ed by the presence of serous
effusion#fibrinopurulent phase, characteri*ed by accumulation ofpolymorphonuclears,
fibrine and pus, with tendency to formationof pleural loculi, adherences and
septations# and chronic ororgani*ation phase characteri*ed by fibroblasts
proliferation andpulmonary incarceration
!"%#
. The 1merican Thoracic Societyclassifies
reaksi pleura ke proses intothree anatomopathological berturut!turut menular fase/
akut atau eudativephase# awal, dicirikan oleh adanya efusi serosa# fase
fibrinopurulent, ditandai dengan akumulasi ofpolymorphonuclears, fibrine dan nanah,
dengan kecenderungan untuk formationof loculi pleura, kepatuhan dan septations#
dan fase ororgani*ation kronis ditandai oleh proliferasi fibroblas andpulmonary
penahanan
!"%#$

The ultrasonographic finding can be classified into five classes, according to the
pleural effusion characteristic/ class , 2 free effusion# class . 2 effusion with little
septation# class 0 2 septate, thick effusion, with grumes# class > 2 loculated effusion,
with multiple septa, debris, pleural thickening and pulmonary consolidation areas#
class 7 2 loculated effusion, with multiple septa and debris, pleural thickening,
defined empyemic sac, pulmonary incarceration and necrosis areas of the
parenchyma
!"%#
+ $igure 9 -. Temuan ultrasonografi dapat diklasifikasikan menjadi
lima kelas, sesuai dengan karakteristik efusi pleura/ ! bebas efusi kelas ,, . kelas !
efusi dengan septation kecil# ! 0 septate, tebal efusi kelas, dengan Grumes# > kelas
loculated efusi !, dengan beberapa septa, puing, penebalan pleura dan daerah
konsolidasi paru# kelas 7 ! efusi loculated, dengan beberapa septa dan puing!puing,
penebalan pleura, pasti kantung empyemic, penahanan paru dan daerah nekrosis
pada parenkim
!"%#
+ Gambar 9 -.
The anatomopathological phases correlate to ultrasonographicfindings. $ase
anatomopathological berkorelasi dengan ultrasonographicfindings. ;e consider as
being in the acute or eudative phase,the effusions presenting ultrasonographic
classification , or .#in the fibrinopurulent phase are those in classifications 0 and>#
and in the chronic or fibrotic phase,those with classification7
!"%#
. <ami menganggap
sebagai atau eudative dalam fase akut, dengan efusi menyajikan klasifikasi
ultrasonografi , atau .# dalam tahap fibrinopurulent adalah pada klasifikasi 0 and>,
dan dalam atau fibrosis fase kronis, mereka dengan classification7
!"%#$

;hen using the anatomopathological classification as a meansto rationali*e conducts,
in the acute phase thoracentesis orwater!seal drainage is indicated. &ila
menggunakan klasifikasi anatomopathological sebagai meansto merasionalisasi
melakukan, pada fase akut Thoracentesis!segel drainase orwater ditunjukkan. The
chronic pleural empyemasrequire thoracotomy for surgical decortication. The
empyemasrequire torakotomi kronis pleura untuk decortication bedah. ;hen the
pleuraldisease reaches an intermediate phase, between eudative andchronic
organi*ed, the loculation, septation and adhesion can beundone by
videothoracoscopy
!"%/">#
. <etika pleuraldisease mencapai tahap intermediate, antara
andchronic eudative terorganisir, loculation itu, septation dan adhesi dapat
beundone oleh videothoracoscopy
!"%/">#$

&INA CONSIDERATIONS &INA PERTI.BAN-AN
The ultrasonography is a modality that can be used in thepleural effusion diagnosis,
particularly in neonates and infants,also allowing the differentiation between
transudative effusionand eudative effusion, orienting its therapeutic ethiology.
ultrasonografi adalah modalitas yang dapat digunakan dalam diagnosis efusi
thepleural, khususnya di neonatus dan bayi, juga memungkinkan perbedaan antara
eudative efusi effusionand transudative, berorientasi ethiology terapi nya. )ncertain
situations, ultrasonography can be superior to plainchest !ray, mainly for detection
of small amounts of effusion,thoracentesis site accuracy, and differentiation of the
locularpleural fluid and the thickened pleura. situasi )ncertain, ultrasonografi dapat
menjadi lebih unggul untuk plainchest !ray, terutama untuk mendeteksi jumlah kecil
dari efusi, Thoracentesis situs akurasi, dan diferensiasi dari cairan pleura
locularpleural dan menebal. 4ain disadvantages becomeevident when the
differentiation of very homogeneous solidlesions is necessary and also when the
acoustic shadow caused bya dense rib does not allow the assessment of the adjacent
image.)n the parapneumonic effusion, ultrasonography is capable ofeffectively
classifying the disease evolutive stage and may guidethe therapeutic action.
kelemahan Utama becomeevident saat diferensiasi homogen solidlesions sangat
diperlukan dan juga saat bayangan akustik disebabkan &ya rusuk padat tidak
memungkinkan penilaian image.)n berdekatan dengan efusi parapneumonic,
ultrasonografi ofeffectively mampu mengelompokkan penyakit evolutif panggung dan
mungkin guidethe terapeutik tindakan.
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