In a healthy human, the pleural space contains a small amount of fluid (about 10 to 20 mL), with a low protein concentration (less than 1.5 g/dL).
Pleural fluid is continuously produced by the parietal circulation in the way of bulk flow, while it is also continuously reabsorbed by the lymphatic system via the stomata in the parietal pleura. Of note, there is a slight increase in the percent of neutrophils found in smokers over nonsmokers. Differential cell counts: 75% macrophages, 23% lymphocytes, and marginally present mesothelial cells (1% to 2%), neutrophils (1%), and eosinophils (0%). The composition of normal pleural fluid consists of total white blood cell count of 1.716 x 10(3) cells mL(-1). In children, congenital heart disease, pneumonia, and malignancy are the most common causes of pleural effusions. Pneumonia, malignant pleural disease, pulmonary embolism, and gastrointestinal disease account for almost all exudative pleural effusions. In adults, congestive heart failure and liver cirrhosis are the most common causes of transudative pleural effusions. Hemothorax - a buildup of blood in the pleural space commonly from injury or trauma to the chest.Pneumothorax - a buildup of air or gas in the pleural space commonly from acute lung injury, trauma, or chronic diseases such as a chronic obstructive pulmonary disease or tuberculosis.Pleural effusion - excess fluid in the pleural space commonly from congestive heart failure or malignancy.Pleurisy - pleura inflammation, causing sharp pain with breathing most commonly caused by a viral infection.The following are some of the most common: Many conditions can cause problems within the pleural cavity and in the pleural fluid. Evaluation of pleural fluid can be used to determine the cause of pleural effusion and help guide the treatment of the underlying cause. The Light criteria is a useful way to differentiate between transudate and exudate, which can then be further evaluated with lab tests and in the context of the clinical presentation of the patient. Pleural fluid serves a physiologic function in respiration, while also being a useful measure to diagnose and assess disease, trauma, and other abnormalities. A brief review of the anatomy and physiology of normal pleural fluid gives a point of reference for assessing the causes of abnormal pleural fluid collections and pleural effusions.
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