Lack of Association of Pleural Effusion with Chronic Pulmonary Arterial and Right Atrial Hypertension

Wiener-Kronish, Jeanine P.; Goldstein, Ruth B.; Matthay, Richard A.; Biondi, James W.; Broaddus, V. Courtney; Chatterjee, Kanu; Matthay, Michael A.

doi:10.1378/chest.92.6.967

Cited by 63 publications

(17 citation statements)

References 5 publications

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“…There is epidemiological evidence that pleural effusion is less frequent in right rather than in left heart failure [24,25]. These observations are not framed into a specific set of functional parameters (microvascular permeability, lymph flow rate, etc.…”

Section: Pathophysiology Of Pleural Effusionmentioning

confidence: 99%

Mechanisms controlling the volume of pleural fluid and extravascular lung water

Miserocchi

2009

European Respiratory Review

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Pleural and interstitial lung fluid volumes are strictly controlled and maintained at the minimum thanks to the ability of lymphatics to match the increase in filtration rate. In the pleural cavity, fluid accumulation is easily accommodated by retraction of lung and chest wall (high compliance of the pleural space); the increase of lymph flow per unit increase in pleural fluid volume is high due to the great extension of the parietal lymphatic. However, for the lung interstitium, the increase in lymph flow to match increased filtration does not need to be so great. In fact, increased filtration only causes a minor increase in extravascular water volume (,10%) due to a marked increase in interstitial pulmonary pressure (low compliance of the extracellular matrix) which, in turn, buffers further filtration. Accordingly, a less extended lymphatic network is needed. The efficiency of lymphatic control is achieved through a high lymphatic conductance in the pleural fluid and through a low interstitial compliance for the lung interstitium. Fluid volume in both compartments is so strictly controlled that it is difficult to detect initial deviations from the physiological state; thus, a great physiological advantage turns to be a disadvantage on a clinical basis as it prevents an early diagnosis of developing disease.

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Section: Pathophysiology Of Pleural Effusionmentioning

confidence: 99%

Mechanisms controlling the volume of pleural fluid and extravascular lung water

Miserocchi

2009

European Respiratory Review

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“…These modest increases in pulmonary artery pressure are unlikely to drive pleural effusion formation. In fact, Wiener-Kronish et al [28,29] demonstrated that pulmonary artery hypertension in the absence of pulmonary venous pressure elevation does not induce pleural effusions.…”

Section: The Role Of Primary Systemic Amyloidosis Cardiomyopathy In Pmentioning

confidence: 99%

Pleural effusions in systemic amyloidosis

Berk

2005

Current Opinion in Pulmonary Medicine

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Large pleural effusions in systemic amyloidosis occur most often in primary systemic amyloidosis, predominantly resulting from direct infiltration of the parietal pleural surface. Left atrial hypertension from primary systemic amyloidosis cardiomyopathy contributes to but is not sufficient to form and sustain these effusions. Untreated patients have a median survival of 1.6 months. Secondary, familial, and senile systemic amyloidosis do not infiltrate the pleural surfaces or induce pleural effusions in a clinically significant fashion.

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“…This is suggested by a positive correlation between extravascular lung water content and PLEF volume, effusate protein concentrations close to those of lung lymphatics [11][12][13], and preserved visceral pleura ultrastructure [13]. The notion that the major source of hydrostatic effusions is the lung is further supported by clinical studies showing that in patients with chronically elevated hydrostatic pressures, the presence of PLEF correlates better with left [14] rather than right heart filling pressures [15]. In hydrostatic and permeability pulmonary edema models, 21-29% of the overall excess fluid formed exits the lung via the visceral pleura into the pleural space [12,13], implying that the parietal pleural absorption is a major pathway for lung edema clearance.…”

Section: Introductionmentioning

confidence: 96%