How to Differentiate Pleural effusion and pleural thickening!

 How to Differentiate Pleural effusion and pleural thickening!

1.On Inspection in Pleural Effusion Intercostal space are full or widened but normal in pleural thickening.In long standing pleural thickening there may flattening of chest.

2.On Palpation (If Pleural effusion is massive)  then trachea and Apex beat will be shifted to opposite side.

3.On Percussion in case of Pleural effusion percussion not is Stony dull,but in Pleural thickening Percussion note is impaired or dull.

4.On Auscultation in Pleural effusion Breath sound is diminished but in Pleural thickening breath sound is absent

5.Investigations

 a)CXR PA view curvilinear Upper border in PE and not in Pleural thickening

b)I lateral decubitus view there is shifting of fluid towards axilla in case of PE but not in Pleural thickening.

c)USG can Differentiate fluid and tissue.So pleural effusion can be Differentiated from thickening by sonography.

b) In bed side Needle aspiration also will confirm Pleural effusion and thickening.If fluid is aspirated then it is PE,if not it is thickened pleura.