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Chest » General
Septate pleural effusion
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Author(s) :
Gunjan Puri, MD
 
Presentation A 22-year-old man presents with history of pulmonary tuberculosis. Chest radiograph shows right pleural effusion. An ultrasound was performed.
 
 
 
Caption: Scan of the right lower thorax
Description: There is evidence of right pleural effusion. Multiple septae are seen within the pleural fluid. This is suggestive of the exudative nature of the pleural fluid.
 
Differential Diagnosis Septate pleural effusion
 
Final Diagnosis Septate pleural effusion
 
Discussion

Ultrasound can aid in the diagnosis of pleural effusion. Based on the ultrasound features, it can also help to differentiate between a transudative and an exudative effusion. This in turn helps to narrow down the differentials for the cause of effusion.
A transudate is always anechoic in nature, while an exudate may show the following features:
1. May be anechoic or echogenic,
2. May show septae within
3. May show debris or other particulate matter within
4. May show loculations
5. May have associated pleural thickening [pleura >3mm]
6. May have associated pleural nodules
7. May have associated lung parenchymal lesions.

A few common causes of transudative pleural effusions are congestive heart failure, cirrhosis of liver, hypoalbuminemia, nephrotic syndrome, etc.
A few common causes of exudative pleural effusions are infections [bacterial, tuberculous], lung malignancy, metastases, lymphoma, collagen vascualr diseases [such as SLE, rheumatoid arthritis], drug-induced, etc.

 
Case References 1. Yang PC, Luh KT, Chang DB, Wu HD, Yu CJ, Kuo SH. Value of sonography in determining the nature of pleural effusion: analysis of 320 cases. AJR Am J Roentgenol. 1992 Jul;159(1):29-33.
2. William Brant in Rumack C., Wilson S., et al. Textbook of Diagnostic Ultrasound, second edition. Chapter 16 -The Thorax. pgs 575-597.
 
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