What are the physical findings of pleural effusion (fluid on the lungs)?

Updated: Dec 28, 2018
  • Author: Kamran Boka, MD, MS; Chief Editor: Guy W Soo Hoo, MD, MPH  more...
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Answer

Physical findings in pleural effusion are variable and depend on the volume of the effusion. Typically, there are no clinical findings for effusions less than 300 mL. With effusions greater than 300 mL, chest wall/pulmonary findings may include the following:

  • Dullness to percussion, decreased tactile fremitus, and asymmetrical chest expansion, with diminished or delayed expansion on the side of the effusion: These are the most reliable physical findings of pleural effusion. [20, 21]
  • Mediastinal shift away from the effusion: This finding is observed with effusions greater than 1000 mL. Displacement of the trachea and mediastinum toward the side of the effusion is an important clue to obstruction of a lobar bronchus by an endobronchial lesion, which can be due to malignancy or, less commonly, to a nonmalignant cause, such as a foreign body obstruction.
  • Diminished or inaudible breath sounds
  • Egophony (known as "E-to-A" changes) at the most superior aspect of the pleural effusion
  • Pleural friction rub

Other physical and extrapulmonary findings may suggest the underlying cause of the pleural effusion.

Peripheral edema, distended neck veins, and S3 gallop suggest congestive heart failure. Edema may also be a manifestation of nephrotic syndrome, pericardial disease, or, when combined with yellow nailbeds, the yellow nail syndrome.

Cutaneous changes and ascites suggest liver disease.

Lymphadenopathy or a palpable mass suggests malignancy. [4]


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