**3. Clinical features**

1. Respiratory causes Parapneumonic effusion

3. Cardiac causes Post Myocardial Infarction

6. Post surgical Coronary artery bypass surgery 7. Autoimmune causes Systemic lupus erythematosus

2. Gastrointestinal causes Pancreatitis

82 Cholesterol - Good, Bad and the Heart

4. Occupational Asbestosis 5. Traumatic Hemothorax

8. Endocrine causes Hypothyroidism

9. Renal related Uremia

10. Malignancies and complications Mesothelioma

12. Lymphatic cause Chylothorax

Tuberculosis sarcoidosis

Parasitic infections Pulmonary embolism

Trapped lung

Postoperative

Intrabdominal abscesses Posttransplant of liver Esophageal perforation

Constrictive pericarditis PostPericardiotomy

Rhematoid pleurisy Drug induced lupus Sjogren syndrome

Peritoneal dialysis

Metastases

11. Drug induced Bromocriptine,Dantrolene, Nitrofurantoin, Amiodarone,etc

Wegener's granulomatosis Chrug strauss Syndrome

Ovarian hyperstimulation syndrome

Superior vena caval obstruction

Endoscopic variceal sclerotherapy

The clinical features of pleural effusion depend on the amount, the rate of accumulation of fluid and the underlying cause. In acute cases, the symptoms appear suddenly. Patients may present with shortness of breath, pleuritic pain, cough and constitutional symptoms. Dyspnea may result from compression of lung tissue and from mechanical alterations in the respiratory muscles as the fluid changes their length-tension relationship. There will be associated symptoms related to the etiology of the pleural effusion. So careful elicitation of history in cases of pleural effusion may streamline the physician toward the etiological aspect of pleural effusion.

Physical examination reveals decreased respiratory movements on the affected side and displacement of mediastinum to the opposite side. If there is an associated collapse of lung or fibrosis, the trachea may be central or may even be pulled to the same side depending on the degree of collapse or fibrosis. Tactile fremitus may be decreased to absent but may also be increased toward the top of large effusion. Percussion reveals dull to flat note over the fluid.

Auscultation reveals decreased to absent breath sounds but bronchial breath sounds may be heard near top of large effusion. Pleural rub can also be heard and sometimes crackles above the level of effusion. Frequently, there are E to A changes (egobronchophony) at the upper fluid border where underlying lung parenchyma is compressed.
