PLEURAL EFFUSION

Created by:

Preceptor
dr. Dedy Zairus, Sp. P

PATIENT IDENTITY
Initial Name: Mr. S
Sex
: Male
Age
: 48 years old
Nationally
: Indonesia (Javanese)
Marital Status : Married
Religion
: Islam
Occupation
: run a private interprise
Educational
: Elementary School
Address
: Bandar Lampung

Chief Complain :
Shortness

of breath since 1 week ago

Additional Complaint :
Cough

HISTORY OF THE PRESENT ILLNESS

Patients present with shortness of breath since 1

week ago. Patients complain of difficulty breathing
while doing activity. Patients feel better when
you're in a sitting position or by using a high pillow.
Shortness of breath arise every day and
compounded with moderate activity. Patients
complain when it is relapse can reach 1-2 hours.
The patient also complained of cough without
phlegm since 1 week ago. The patient had been
undergoing treatment at the general hospital Bumi
Waras. But in reference to Abdul Moeloek Bandar
Hospital. Patients admitted to having obtained an
ultrasound examination of the abdomen and liver
irritation.

THE HISTORY OF ILLNESS

(-)

Small pox

(-)

Malaria

(-)

Kidney stone

(-)

Chicken pox

(-)

Disentri

(-)

Hernia

(-)

Difthery

(-)

Hepatitis

(-)

Prostat

(-)

Pertusis

(-)

TifusAbdominalis

(-)

Melena

(-)

Measles

(-)

Skirofula

(-)

Diabetic

(+)

Influenza

(-)

Siphilis

(-)

Alergy

(-)

Tonsilitis

(-)

Gonore

(-)

Tumor

(-)

Kholera

(-)

Hipertension.

(-)

Vaskular Disease

(-)

Acute Rheumatoid Fever

(-)

Ventrikuli Ulcer

(-)

Operation

(-)

Pneumonia

(-)

Duodeni Ulcer

(-)

Pleuritic

(-)

Gastritis

Is there any family who suffer :

Patient said that no one of the family members of the patient has been
sick TB.

SYSTEM ANAMNESE

EARS
(-)

Pain

(-)

Tinitus

(-)

Secret

(-)

Ear disorders

(-)

Deafness

NOSE
(-)

Trauma

(-) Clogging

(-)

Pain

(-) Nose disorders

(-)

Sekret

(-) common cold

(-)

Epistaksis

MOUTH
(-)

Lip

(-)

Dirty Tongue

(-)

Gums

(-)

Mouth disorders

(-)

Membrane

(-)

Stomatitis

Throat
(+)

Throat Pain

(-) Voice Change

Protruding

(-) Neck Pain

Neck
(-)

Cor/ Lung
(+)

Chest pain

(+) Dyspneu

(-)

Pulse

(-) Hemoptoe

(-)

Ortopneu

(+) Cough

Abdomen (Gaster/ Intestine)

(-)
(-)

Puffing
Nausea

(-)
(-)

Acites
Hemoroid

(-)

Emesis

(-)

Diarrhea

(-)

Hematemesis

(-)

Melena

(-)

Disfagi

(-)

Pale colour of feses

(-)

Colic

(-)

Black colour of feses

(-)

Nodul

Urogenital
(-)

Dysuria

(-)

Pyuria

(-)

Stranguria

(-)

Kolik

(-)

Polyuria

(-)

Oliguria

(-)

Polakysuria

(-)

Anuria

(-)

Hematuria

(-)

Urine retention

(-)

Kidney stone

(-)

Drip urine

(-)

Wet the bed

(-)

Prostat

THE HISTORY OF LIFE

GENERAL CHECK UP
Heigh
: 144 cm
Weight
: 42 kg
Blood Pressure
: 110/60 mmHg
Pulse
: 84 x/minute
Temperature
: 36,1 0C
Breath (Frequence&type) : 24 x/minute
Nutrition Condition
: Normal,
Consciousness
: Compos Mentis
Cyanotic
: (-)
General Edema
: pitting oedem (-)
The way of walk
: normal
Mobility
: Aktive
The age predicyion based on check up : 45 years old

SKIN
Color
Keloid
Pigmentasi
Hair Growth
Arteries
Touch temperature
Humid/dry
Sweat
Turgor
Icterus
Fat Layers
Efloresensi
Edema
Others

: Olive
: (-)
: (-)
: Normal
: Touchable
: Afrebris
: Dry
: Normal
: Normal
: anicteric
: Enough
: (-)
: (-)
: (-)

Anichterik

Lung
Inspection
: Left : asimetric, no lession, normochest
Right
: simetric, no lession, normochest
Palpation: Left : vokal fremitus decreased, pain (-)
Right
: vokal fremitus normal, pain (-)
Percussion : Left : Sonor
Right
: sonor
Auscultation: Left : vesiculer decrease, wheezing expiration (-), ronkhi (+)
Right
: vesiculer, wheezing expiration (-), ronkhi (-)

Stomach
Inspection
: convex
Palpation: Stomach Wall : undulation (-), pain (-)
Heart
: Hepatomegali (-)
Limfe
: Splenomegali (-)
Kidney
: Ballotement (-)
Percussion
: Shifting Dullness (-)
Auscultation: Intestine Sounds (+) normal

CLINICAL PATHOLOGY
Assesment

Outcome

Ureum

16 mg/dl

Creatinine

0,7

Glucose

69 mg/dl

BTA

: S (-)
P (-)
S (-)

Normal Range

CHEST X-RAY

SUPPORT CHECK UP
Laboratory
Ureum

Creatinin
Electrolite
GDS
Lipid Profile
Uric Acid
Albumin

TREATMENT PLAN
General Treatment
Bed Rest
Nutrition (high calory, high protein)
Special Treatment
Medicamentosa
IVFD

RL : D5 gtt X/minute
Cetirizin tab 2x1
Ranitidin 2x1 amp
Ciprofloxacine 500mg/12 jam
Dexamethasone 3x1 amp
Antasid tab 3x1

Non

Medicamentosa

Therapeutic
WSD

Pleurodesis
Activity

thoracentesis

adjustment
Go to doctor immedietly if appear any symptoms

Prognose
Quo ad Vitam
: dubia
Quo ad Functonam
: dubia
Quo ad Sanationam
: dubia ad malam

PLEURAL EFFUSION

Pleural effusion means the collection of large

amounts of free fluid in the pleural space.

Etiology include:
blockage of lymphatic drainage from the pleural
cavity
cardiac failure
greatly reduced plasma colloid osmotic pressure
infection or any other cause of inflammation of
the surfaces of the pleural cavity

RADIOLOGY
At least 175 mL of fluid is needed for the effusion
to be visualized on plain radiograph, whereas a
large pleural effusion may completely opacify the
hemithorax.
The most common manifestation of pleural
effusion on upright radiograph is a fluid level in
the hemithorax
Small amounts of pleural fluid may be manifest
as a meniscus that blunts the costophrenic angle
on the PA projection
Atelectasis of a lobe can also be present with
pleural effusions.

PLEURAL FLUID DIAGNOSTIC TESTS

The first step is to determine whether the

effusion is a transudate or an exudate.
transudative pleural effusion occurs when
systemic factors that influence the formation
and absorption of pleural fluid are altered
An exudative pleural effusion occurs when local
factors that influence the formation and
absorption of pleural fluid are altered

CRITERIA EXUDATIVE PLEURAL

EFFUSIONS
Pleural fluid protein/serum protein >0.5

Effusion due to heart failure

THERAPY
Medicamentosa

REFERENCE
Longo DL, Fauci AS, Kasper DL, Hauser SL,
Jameson JL, and Loscalzo J. 2012. Harrisons
Principles of Internal Medicine 18th Edition.
United States : McGraw-Hill eBooks.
Maskell NA and Butland RJA.2011. BTS
guidelines for the investigation of a unilateral
pleural effusion in adults. thorax.bmj.com on July
16, 2011.
Rahman NM and Munawar M. 2009.
Investigation of the patient with pleural effusion.
Clin Med 2009;9:1748.

THANK
YOU