Pleural effusion grading

Pleural effusion refers to the substance in our chest cavity. Everyone in our body has this substance, not only adults, but children as well. However, the range of pleural effusion is different for each person, but we basically have a normal atmosphere. However, there are still many people who do not understand its normal range. So what is the grading of pleural effusion?

The range of small pleural effusion is 300-500ml, the range of moderate pleural effusion is 500-800ml, and the range of large pleural effusion is >800ml. The physiological amount of fluid accumulation is about 240ml. That is, the normal value is about 240ml.

Pleural effusion refers to a pathological change in which the fluid in the pleural cavity exceeds the normal range due to any physical reason that causes its production to increase or its absorption to decrease. Pleural effusions are divided into two types: exudates and transudates. Under normal circumstances, the pleural cavity is in a state of negative pressure and contains only a small amount of serous fluid, which acts as a lubricant. In a normal person, there is 3ml to 15ml of fluid in the pleural cavity, which acts as a lubricant during breathing, but the amount of fluid in the pleural cavity is not fixed. Even for normal people, 500ml to 1000ml of fluid is produced and absorbed every 24 hours. Depending on the nature of the fluid in the pleural effusion, it can be mainly divided into the following categories: serous, blood (hemothorax), fatty (chylothorax), and purulent (empyema).

Look at the front ribs, the second and fourth front ribs are the boundaries, the ones below the fourth rib are in small quantities, less than 500, the ones between 2-4 ribs are in medium quantities, about 1000, and the ones above the second rib are greater than 1500! Another method is to observe the changes in the costophrenic angle.

The hilum of the lung, and then the part beyond the hilum of the lung! The meaning is similar to the previous one! As for closed drainage, if the amount is small, thoracentesis can be performed! If there are indications, you can release the drug, there is no specific value!

When there is a small amount of pleural effusion, the fluid accumulates in the lowest part of the pleural cavity - the costophrenic angle. The X-ray chest image can show a flattening of the costophrenic angle. At this time, the estimated amount of pleural effusion is about 200 ml. When there is a moderate amount of pleural effusion, the standing posteroanterior X-ray chest image shows that the fluid exceeds the diaphragm surface, presenting a typical exudate curve that is low on the inside and gradually rises and becomes steeper toward the outside.

When judging the amount of pleural effusion by X-ray, when the arc-shaped liquid surface of the exudate curve of a large amount of pleural effusion exceeds the upper edge of the hilum of the lung, only a small part of translucent lung tissue can be seen on the inner side of the apex of the lung on the X-ray chest image, and the affected side may also appear opaque; at the same time, the chest cavity on the affected side is full, the intercostal space is widened, and the ribs are raised horizontally; the heart shadow shifts to the healthy side, and the trachea shifts to the healthy side; when there is a large amount of pleural effusion on the left side, the arched dome of the diaphragm reverses downward in the expiratory phase, and moves upward in the inspiratory phase, forming a contradictory movement of the diaphragm. This phenomenon only occurs on the left side, especially when the gastric bubble is obvious, it can be clearly observed under fluoroscopy. Having the liver under the right diaphragm can prevent reversal of the right diaphragm.

This dividing line is a transition zone of change in X-ray projection density and does not truly represent the state of intrathoracic fluid presence. The formation of the exudate curve is due to the fact that the fluid close to the lateral chest wall is in a tangential relationship with the X-ray, so the height of the liquid level can be displayed. In the middle and inner sides of the chest cavity where the lung tissue exists, the fluid exists in front and behind the lungs, and the state of the lung suspended in the pleural effusion is that the mediastinum side is wider and thicker, and the lung tissue gradually becomes thinner towards the outside. That is, the thickness of the fluid in the chest on the X-ray projection is the thinnest on the inside, and becomes thicker towards the outside. At the same time, with the background of lung tissue, even if the plane of the effusion in the chest cavity is at the same height, the liquid level shown on the X-ray chest image gradually becomes lower from the outside to the inside. On a lateral chest image, a moderate amount of pleural effusion appears as an arc-shaped exudate curve across the anterior and posterior chest cavity, which is higher in the anterior and posterior regions and lower in the middle. When a patient undergoes thoracentesis and treatment, gas may overflow into the chest cavity, appearing as a fluid-air level on the chest X-ray.