Pleural effusions occur as the result of significant pleural or systemic disorders ( Table 1). Pleuritic pain, cough, and dyspnea are common findings in patients with pleural effusions. Pleural pain is caused by irritation of the intercostal sensory nerves supplying the parietal pleura. Inflammation of the parietal pleura results in pain localized to the overlying chest wall. The central diaphragm is innervated by the phrenic nerve, and inflammatory processes involving this region result in referred pain to the ipsilateral shoulder. The visceral pleura contains no somatic sensory nerves. Dyspnea is frequently present. Possible causes are decreased vital capacity, pleural splinting, and mechanical distortion of the lung and chest wall.
Table 1 Etiologies of pleural effusions
Careful physical examination may reveal decreased breath sounds and dullness to percussion. The presence of free pleural fluid may be confirmed by changes in percussion dullness with changes in patient position.
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