[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Clinical exam](https://durgical.com/en/clinical-exam/) › [Respiratory system](https://durgical.com/en/clinical-exam/#a-respiratory) › Pleural effusion syndrome [Clinical exam](https://durgical.com/en/clinical-exam/) · [Respiratory system](https://durgical.com/en/clinical-exam/#a-respiratory) # Pleural effusion syndrome - Syndrome Fluid between the lung and the chest wall: the base sounds dull and voice and breath sounds are barely heard. Updated 2026-11-01 **See it in 3D:** [Pleura](https://durgical.com/en/anatomy/pleura/) · [Diaphragm](https://durgical.com/en/anatomy/diaphragm/) ## Key points - Stony basal dullness with reduced or absent fremitus and breath sounds: effusion. - Egophony and soft bronchial breathing may be heard at the upper border, where the lung is compressed. - A massive effusion shifts the trachea and mediastinum to the opposite side. - The commonest transudate is heart failure; the commonest exudates are parapneumonic effusion and cancer. - In Colombia, tuberculous pleurisy is an important cause of exudate in young people. - Small effusions are missed on exam; ultrasound finds them and guides thoracentesis. ## What it is A pleural effusion is fluid collecting in the pleural space. The fluid lies between lung and wall, damps vibration and sound, and gathers first at the bases by gravity. It is a transudate (pressure imbalance, as in heart failure) or an exudate (inflammation or tumour of the pleura, as in pneumonia, tuberculosis or cancer). ## Key findings - Light's criteria (fluid protein and LDH compared with serum) separate exudate from transudate. - Persistent fever with an effusion in a patient with pneumonia calls for ruling out empyema. ## Pathophysiology - The pleura normally holds a very thin film of fluid that is made and absorbed in balance. - Transudate: hydrostatic pressure rises or oncotic pressure falls (heart failure, cirrhosis, nephrotic syndrome). - Exudate: pleural permeability rises or lymphatic drainage is blocked (infection, tumour, autoimmune disease). - Upright, fluid collects first in the posterior costodiaphragmatic recess. | Inspection | Palpation (fremitus) | Percussion | Auscultation | | --- | --- | --- | --- | | [Small to moderate: expansion ↓ on that side; trachea midline](https://durgical.com/en/conditions/pleural-effusion/) | Reduced fremitus at the base | Basal dullness with a border rising toward the axilla | Reduced breath sounds; egophony at the upper border | | [Massive: hemithorax full and still; trachea to the opposite side](https://durgical.com/en/conditions/pleural-effusion/) | Absent fremitus | Dullness over the whole hemithorax | Breath and voice sounds absent | ## Common causes - Heart failure (transudate, often bilateral). - Pneumonia with parapneumonic effusion or empyema. - Tuberculous pleurisy. - Lung cancer, pleural metastases and mesothelioma. - Pulmonary embolism, cirrhosis, nephrotic syndrome; haemothorax after trauma. ## Tests that confirm it - Chest radiograph: blunted costophrenic angle and a meniscus. - Pleural ultrasound: detects small volumes and guides the tap. - Thoracentesis with fluid analysis (Light's criteria, chemistry and cell count, culture, cytology; adenosine deaminase if tuberculosis is suspected). ## Test yourself Think of the answer, then tap the question to see it. ## Which voice finding may be heard at the upper border of an effusion? Egophony, from the compressed lung just above the fluid. ## Which way does a massive effusion push the trachea? To the opposite side, from the mass effect of the fluid. ## What is the most common cause of a pleural transudate? Heart failure. ## Which imaging test finds small effusions and guides the tap? Pleural ultrasound. [Add to my cards (4)](https://durgical.app/estudiar/?add=/en/clinical-exam/pleural-effusion-syndrome/) ## See it in 3D The structures of Durgical's 3D anatomy where it is found. - [Pleura](https://durgical.com/en/anatomy/pleura/) - [Diaphragm](https://durgical.com/en/anatomy/diaphragm/) ## Related - [The pleuropulmonary syndromes: the comparison table to know](https://durgical.com/en/clinical-exam/the-pleuropulmonary-syndromes-the-comparison-table-to-know/) - [Chest percussion: resonance, dullness and hyperresonance](https://durgical.com/en/clinical-exam/chest-percussion-resonance-dullness-and-hyperresonance/) - [Voice sounds: bronchophony, egophony and whispered pectoriloquy](https://durgical.com/en/clinical-exam/voice-sounds-bronchophony-egophony-and-whispered-pectoriloquy/) - [Pneumothorax syndrome](https://durgical.com/en/clinical-exam/pneumothorax-syndrome/) - [Heart failure syndrome: left- and right-sided signs](https://durgical.com/en/clinical-exam/heart-failure-syndrome-left-and-right-sided-signs/) ## Related conditions - [Pleural effusion](https://durgical.com/en/conditions/pleural-effusion/) - [Parapneumonic effusion and empyema](https://durgical.com/en/conditions/parapneumonic-effusion-and-empyema/) - [Heart failure](https://durgical.com/en/conditions/heart-failure/) - [Pulmonary tuberculosis](https://durgical.com/en/conditions/pulmonary-tuberculosis/) - [Haemothorax](https://durgical.com/en/conditions/haemothorax/) - [Lung cancer](https://durgical.com/en/conditions/lung-cancer/) [← All of the clinical exam](https://durgical.com/en/clinical-exam/) Educational content on the clinical exam; it is learned and practised under supervision. It does not replace assessment by a health professional and is not for self-diagnosis. Sources: [Pleural effusion: MedlinePlus Medical Encyclopedia](https://medlineplus.gov/ency/article/000086.htm) (MedlinePlus, U.S. National Library of Medicine, 2024); [Breath sounds: MedlinePlus Medical Encyclopedia](https://medlineplus.gov/ency/article/007535.htm) (MedlinePlus, U.S. National Library of Medicine, 2024). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/clinical-exam/pleural-effusion-syndrome/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/clinical-exam/pleural-effusion-syndrome/