LOWER

RESPIRATORY
TRACT INFECTION
BY NEETHUPAUL
TOPIC

Pleural effusion

Pulmonary embolism
PLEURAL
EFFUSION
INTRODUCTION

• Pleural effusion is the abnormal accumulation of

fluid in the pleural space, which is the thin cavity
between the lungs and the chest wall. Normally,
the pleural space contains a small amount of fluid
(about 10-20 mL) that lubricates the movement of
the lungs during breathing. In pleural effusion,
excess fluid builds up, impairing the lungs’ ability
to expand fully, which can cause difficulty
breathing and other complications.
TYPE

• Pleural effusions can be classified based on the nature of the

fluid or the underlying cause:
• Transudative Pleural Effusion:Results from an imbalance between
hydrostatic and oncotic pressure in the blood vessels. It is
typically due to systemic conditions that affect fluid balance
rather than lung diseases. Common causes include:
• Congestive heart failure (CHF): The most common cause, where
increased pressure in the blood vessels of the lungs causes fluid
to leak into the pleural space.
• Cirrhosis: Low protein levels and fluid retention from liver
disease can lead to pleural effusion
• Nephrotic syndrome: Kidney disease causing low protein levels
(hypoalbuminemia), which reduces oncotic pressure and allows
fluid to accumulate.
TYPE

• 2. Exudative Pleural Effusion:Occurs due to inflammation or injury to the pleura,

which increases the permeability of the blood vessels, allowing fluid, proteins,
and immune cells to leak into the pleural space.Common causes include:
• Pneumonia: Infection of the lungs can cause an inflammatory response in the
pleura, leading to an effusion (parapneumonic effusion).
• Cancer (malignancy): Lung cancer, breast cancer, or metastatic cancers can
cause pleural effusions by direct invasion or obstruction of lymphatic drainage.
• Pulmonary embolism: A blood clot in the lung’s blood vessels can cause
inflammation and exudation of fluid into the pleural space.
• Tuberculosis: TB can lead to chronic pleural inflammation and effusion.
• Autoimmune diseases: Conditions like lupus or rheumatoid arthritis can cause
inflammation of the pleura, leading to an exudative effusion.
SYMPTOMS

• Dyspnea (Shortness of Breath): The most

common symptom, caused by fluid compressing
the lungs and reducing their ability to expand.
• Chest Pain: Sharp, pleuritic pain that worsens
with breathing or coughing, particularly in
exudative effusions associated with inflammation.
• Cough: Usually dry and non-productive.
• Decreased breath sounds and dullness to
percussion over the area of fluid collection.
• Orthopnea (difficulty breathing while lying flat) or
symptoms related to the underlying cause (e.g.,
leg swelling in heart failure, fever in infection).
DIAGNOSIS

• 1. Clinical Examination:Decreased breath

sounds and dullness to percussion over the
area of the effusion.Reduced chest expansion
on the affected side.Friction rub may be
heard if there is inflammation of the pleura.
• 2. Chest X-ray:Can show fluid accumulation,
usually at the lung bases. Large effusions
may show a “blunting” of the costophrenic
angle.A lateral decubitus view (lying on the
side) may be used to confirm fluid mobility
and estimate the volume of effusion.
DIAGNOSIS

• 3. Ultrasound: More sensitive than a chest X-ray in

detecting small amounts of pleural fluid. Helps guide
thoracentesis (fluid aspiration) and assess the
characteristics of the fluid
• 4. CT Scan: Provides more detailed imaging of the
lungs and pleura, especially useful in identifying
underlying causes like tumors or abscesses.
• 5. Thoracentesis: A needle is inserted into the pleural
space to withdraw fluid for diagnostic analysis. The
fluid is analyzed for: Protein levels Lactate
dehydrogenase (LDH) levels Cell counts (e.g., white
blood cells, red blood cells)Glucose and pH levels
Cytology to check for malignant cells if cancer is
suspected Microbiological cultures if infection is
suspected
DIAGNOSIS

• Light’s Criteria:Used to differentiate

between transudative and exudative
effusions. According to Light’s
criteria, fluid is considered exudative
if one or more of the following are
met:Pleural fluid protein to serum
protein ratio > 0.5Pleural fluid LDH to
serum LDH ratio > 0.6Pleural fluid
LDH > 2/3 of the upper limit of
normal serum LDH
 • 1. Treating the Underlying Cause: Heart Failure: Diuretics
(e.g., furosemide) to reduce fluid overload. Infections
(Pneumonia/Tuberculosis): Appropriate antibiotics or
antitubercular drugs. Cancer: Treatment of the underlying
malignancy, such as chemotherapy or radiotherapy.
• 2. Thoracentesis: A procedure to drain the fluid from the
TREATMENT pleural space to relieve symptoms (such as dyspnea) and
for diagnostic purposes. Temporary relief, as the effusion
may recur if the underlying cause is not addressed.
• 3. Chest Tube Insertion: For large or recurrent effusions,
especially those complicated by infection (empyema), a
chest tube may be inserted to drain the fluid
continuously.
TREATMENT

• 4. Pleurodesis: A procedure used for recurrent

effusions, especially in cancer patients. A chemical
irritant (such as talc) is introduced into the pleural
space, causing the pleura to adhere to the lung and
chest wall, preventing further fluid accumulation.
• 5. Surgical Intervention: In cases of complicated or
loculated effusions (where the fluid is trapped in
pockets), video-assisted thoracoscopic surgery (VATS)
may be required to drain the effusion and treat the
underlying cause, such as infection or tumor.
• 6. Pleuroperitoneal Shunt: In rare cases, a shunt may
be placed to transfer fluid from the pleural space to
the abdomen in patients with recurrent effusions who
are not candidates for other procedures.
PULMONARY
EMBOLISM
INTRODUCTION

• Pulmonary embolism (PE) is a critical

condition characterized by the sudden
blockage of one or more pulmonary
arteries in the lungs, most commonly
caused by blood clots that travel from
veins in the legs or other parts of the
body (deep vein thrombosis or DVT).
The blockage impairs blood flow to
parts of the lung, leading to a variety
of physiological disruptions that can be
life-threatening if untreated.
 • Prolonged immobility (e.g., long flights, bed rest after
surgery or injury).
• Surgery (particularly orthopedic procedures, such as hip
or knee replacements).
• Trauma (e.g., fractures, particularly of the long bones).
• Cancer (due to both the malignancy itself and treatments

CAUSES like chemotherapy, which can increase clot risk)

• Pregnancy and the postpartum period.Use of oral
contraceptives or hormone replacement therapy.
• Genetic conditions causing hypercoagulability (e.g.,
Factor V Leiden mutation, protein C or S deficiency).
• Obesity and smoking.Chronic diseases such as heart
failure, inflammatory bowel disease, or nephrotic
syndrome.
SYMPTOMS

• Dyspnea (shortness of breath): The most common symptom,

often sudden and unexplained.
• Pleuritic chest pain: Sharp, stabbing pain that worsens with deep
breathing, coughing, or movement.
• Tachycardia (rapid heart rate): Due to increased strain on the
heart.
• Tachypnea (rapid breathing): A compensatory response to low
oxygen levels.
• Cough: Sometimes with blood-streaked sputum (hemoptysis).
• Leg pain or swelling: Indicative of DVT, the source of the
embolus.
• Syncope (fainting): In cases of massive PE, due to sudden drop in
blood pressure.
• Cyanosis: Bluish discoloration of the lips or skin in severe cases
of hypoxia.
DIAGNOSIS

• 1. Clinical Assessment:Signs such as rapid

breathing, rapid heart rate, low oxygen levels,
and symptoms of DVT.Clinical prediction rules
like the Wells score or Geneva score are used
to assess the likelihood of PE.
• 2. D-dimer Test:A blood test measuring a
substance released when blood clots break
down. Elevated D-dimer levels suggest the
presence of an abnormal clot, though the test
is non-specific.
DIAGNOSIS

• 3. Imaging Studies: CT Pulmonary Angiography (CTPA): The

gold standard for PE diagnosis, providing detailed images
of the pulmonary arteries to detect the presence of clots.
Ventilation-Perfusion (V/Q) Scan: Used in cases where CTPA
is contraindicated, this test assesses the distribution of air
and blood flow in the lungs to detect mismatch, indicating
PE.Doppler Ultrasound: Used to detect DVT in the legs,
which may be the source of the PE.
• 4. Electrocardiogram (ECG):Common findings in PE include
sinus tachycardia, right heart strain (e.g., right bundle
branch block), or an S1Q3T3 pattern. However, these
findings are not definitive for PE.5. Echocardiography:
Useful for assessing right heart strain, particularly in
massive PE. It can show right ventricular enlargement or
dysfunction.
TREATMENT

• 1. Anticoagulation Therapy: The mainstay of treatment

to prevent further clot formation: Heparin (usually low-
molecular-weight heparin or unfractionated heparin) is
used initially. Oral anticoagulants such as warfarin, direct
oral anticoagulants (DOACs) like rivaroxaban, apixaban,
or dabigatran are used for long-term management. The
duration of treatment depends on the cause and
recurrence risk, typically ranging from 3 months to
lifelong in high-risk patients.
• 2.Thrombolytic Therapy: For massive PE with
hemodynamic instability, thrombolytics (clot-busting
drugs like alteplase) may be administered to rapidly
dissolve the clot. This treatment carries a higher risk of
bleeding and is reserved for severe cases.
TREATMENT

• 3. Surgical or Catheter-Based
Interventions:Surgical embolectomy may
be necessary for massive PE in patients
who cannot undergo thrombolysis.Catheter-
directed thrombolysis or clot retrieval can
be performed in specialized centers.
• 4. Inferior Vena Cava (IVC) Filter:For
patients who cannot receive
anticoagulation, an IVC filter is used
SUMMARY
QUESTION
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