Friday, April 14, 2017

A Case Of Encysted Pleural Effusion

A 26 years male came to radiology department for X-ray chest with history of cough and fever.
The X -Ray is shown below:

Radiological Findings On X-Ray Examination:
X-ray chest (in the picture above) shows encysted pleural effusion (arrow) along left lateral chest wall, i.e. costoparietal in position, and on right side there is free pleural effusion (twin arrow).

Comments And Explanation: 
The chest radiographic appearance depends on the site of the loculus, the amount of fluid and the radiographic projection. When seen en face it usually appears as an oval opacity, its margin partially well-defined and partially ill defined. When viewed tangentially, it is sharply defined on its convex pulmonary aspect. In moderate and massive effusion there is significant shift of the trachea and the apex of the heart to the opposite side. In the case of encysted effusions the inner margins may be more convex and the mediastinal shift minimal. If the encystment occurs in the interlobar regions there may be formation of rounded or oval opacities which may resemble a tumor.
This may disappear with treatment and hence these are termed pseudo-tumors or phantom tumors. Chest
ultrasound and CT is helpful to differentiate pleural fluid and other pleural and chest wall lesions.

Diagnosis In The Above Case: Encysted pleural effusion

Clinical Discussion: 
Patient may present with dyspnea, chest pain, cough and symptoms of underlying cause. In encysted pleural effusion fluid accumulates between the two layers of visceral pleura within the fissure or between partially fused parietal and visceral pleura adjacent to chest wall, diaphragm or mediastinum.

Encysted effusion can either be:

  • costoparietal, 
  • interlobar,
  • subpulmonic or 
  • mediastinal. 

Costoparietal effusion is the commonest and most often results from infections. Interlobar encystment comes next in frequency and most often results from congestive cardiac failure.

Causes: Tuberculosis is the commonest cause of encysted pleural effusions, followed by pyogenic infection and congestive cardiac failure.

Management: Aspiration of fluid is the treatment of choice. Ultrasound guided needle aspiration
is helpful for costoparietal effusion

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