DIAGNOSIS DAN

TATALAKSANA EFUSI PLEURA

Dr. Hadisono, Sp.P

PERHIMPUNAN DOKTER PARU INDONESIA DEPOK

 Definisi
• Akumulasi cairan pleura di
rongga pleura.

1. Lights RW. Pleural Diseases. 5th ed. Lippincott Williams and Wilkins.2007
2. Fishmans Pulmonary Diseases and Disorder. 5 th ed.
Fisiologi Cairan Pleura
Pembentukan/ Asal Absorpsi
1. Aliran limfatik
1. Kapiler Pleura
2. Kapiler Pleura visceral
2. Interstitial
- Edema paru (kardiogenik dan non
kardiogenik)
3. Rongga peritoneum
- Hepatic hydrothrorax
- Meigs Syndrom
- Pertioneal dialisis
4. Ductus Thoracicus
- ec Trauma atau penyakit lain

1. Lights RW. Pleural Diseases. 5th ed. Lippincott Williams and Wilkins.2007
2. Fishmans Pulmonary Diseases and Disorder. 5th ed.
Fisiologi Produksi dan Penyaliran Cairan Pleura
RONGGA PLEURA
PLEURA PARIETAL PLEURA VISCERAL
Tekanan
Hidrostatik

+30 +24
-5
+35 +29

+6

+5

+34 Tekanan +34

+29 Onkotik +29

Lights RW. Pleural Diseases. 5th ed. Lippincott Williams and Wilkins.2007
Patofisiologi Efusi Pleura
Rate of Fluid Rate of fluid Removal
Accumulation

1. Perubahan permebilitas membran

2. Penurunan tekanan onkotik intravaskular
3. Peningkatan tekanan hidrostatik kapiler
4. Obstruksi saluran limfe

1. Lights RW. Pleural Diseases. 5th ed. Lippincott Williams and Wilkins.2007
2. Fishmans Pulmonary Diseases and Disorder. 5 th ed.
 Penyebab Efusi Pleura
• Peningkatan Pembentukan
6. Peningkatan cairan di rongga peritoneum
1. Peningkatan Cairan Intertitial • ascites dan dialisis peritoneal
• CHF, pneumonia, emboli paru 7. Ruptur duktus torasikus
2. Peningkatan tekanan Intravaskular 8. Ruptur pembuluh darah
• Gagal jantung (ventrikel kanan dan kiri), SVCS
• Penurunan Absorpsi
3. Peningkatan permebilitas kapiler
• Inflamasi pleura, peningkatan VEGF
1. Obstruksi saluran limfe

4. Peningkatan protein cairan Pleura 2. Peningkatan tekanan vaskular sistemik

• SVCS dan gagal jantung kanan
5. Penurunan tekanan pleura
• Atelektasis, peningkatan elastik recoil paru 1. Kerusakan sistem aquaporin di pleura?

1. Lights RW. Pleural Diseases. 5th ed. Lippincott Williams and Wilkins.2007
2. Fishmans Pulmonary Diseases and Disorder. 5 th ed.
 Diagnosis Efusi Pleura
• Anamnesis Foto toraks
• Keluhan Sesak
• Sesak berkurang jika tidur miring ke sisi
yang sakit
• Nyeri dada (nyeri pleuritik)
• Batuk
• Demam
• Pemeriksaan Fisis
• I: asimetris kanan tertinggal saat dinamis,
saat statis dada kanan lebih cembung
• P: fremitus taktil kanan melemah
dibanding kiri
• P: redup/ sonor
• A: suara napas kanan menghilang
1. Lights RW. Pleural Diseases. 5th ed. Lippincott Williams and Wilkins.2007
2. Fishmans Pulmonary Diseases and Disorder. 5 th ed.
FOTO TORAKS : Meniscus Sign

1.Chan O. ABC Emergency Radiology 3rd . Wiley-Blackwell.2013

2. www.learningradiology.com
Foto toraks : Meniskus Sign

1.Chan O. ABC Emergency Radiology 3 rd . Wiley-Blackwell.2013

2. www.learningradiology.com
 Foto toraks: Loculated Pleural Effusions

1.Chan O. ABC Emergency Radiology 3rd . Wiley-Blackwell.2013

2. www.learningradiology.com
Foto toraks: Hydropneumothorax

1.Chan O. ABC Emergency Radiology 3 rd . Wiley-Blackwell.2013

2. www.learningradiology.com
USG TORAKS
Efusi simplex Efusi complex

1.Chan O. ABC Emergency Radiology 3 rd . Wiley-Blackwell.2013

2. www.learningradiology.com
Evaluasi Pasien Efusi Pleura

Porcel JM and Light RW. Diagnostic Approach to Pleural Effusion in Adults. American Family Physician. 2006
Evaluasi Pasien Efusi Pleura

Porcel JM and Light RW. Diagnostic Approach to Pleural Effusion in Adults. American Family Physician. 2006
 Analisis CP (eksudat dan
transudat)
Differences Transudate Exudate
Typical Clearance clear Clear, cloudy or bloody
Protein
Absolute value < 3 gr/dL > 3 gr/dL
Pleural fluid/ serum ratio < 0,5 > 0,5

LDH
Absolute value < 200 IU/L >200 IU/L
Pleural fluid/ serum ratio <0,6 >0,6

Glucose >60 mg/dL < 60 mg/dL

Leucocytes <1000/mL >1000/mL
PMN <50% >50%
Erithrocytes < 5000/mL Variable

1. Light RW. Pleural Disease.5th ed. Philadelphia: Lippincot William and Wilkins;2007
2. Fishman AP. Fishman’s Pulmonary Disease and Disorders 4 th ed. New York: McGraw Hill; 2007.
Tatalaksana Efusi Pleura : torakosintesis
Lokasi Triangle of Safety USG GUIDED

Pulmonologi Intervensi dan Gawat Darurat Napas. FKUIJakarta,2010

Tatalaksana Efusi Pleura : torakosintesis
Torakosintesis Teknik torakosintesis

Pulmonologi Intervensi dan Gawat Darurat Napas. FKUIJakarta,2010

Tatalaksana Efusi Pleura
Chest Tube Drainage Indwelling Pleural Catheter

Pulmonologi Intervensi dan Gawat Darurat Napas. FKUIJakarta,2010

THANKS