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Difference Between Pulmonary Infiltrate and Effusion

A pulmonary infiltrate is when there is fluid or some unusual substance in the lung tissue. An effusion is when there is too much pleural fluid around the lungs.

What is Pulmonary infiltrate?

Definition:

A pulmonary infiltrate is the term used to describe the presence of some unusual substance in the lungs such as, for instance, pus or blood.

Symptoms:

One of the first symptoms of an infiltrate is dyspnea; other notable symptoms besides difficulty with breathing include a fever, pain in the chest, lowered oxygen levels, and a dry cough.

Diagnosis:

A physical exam will indicate symptoms of a possible pulmonary infiltrate. An infiltrate in the lungs can be positively diagnosed by using a chest X-ray, MRI or CT scan, which will show the presence of the substance on the image. 

Causes and complications:

The presence of infiltrates in the lungs is quite common in patients who are in intensive care in the hospital. In about 1/3 of such patients the infiltrates are a result of pneumonia. Cardiac failure, fibrosis in the lungs, tuberculosis, bleeding in the lungs, and adult respiratory distress syndrome (ARDs) are other potential causes of infiltrates. Infiltrates can result in oxygen being too low, which compromises all the cells of the body and can result in death. 

Treatment:

Treatment depends on the cause of the condition, with antibiotics used for treating bacterial infections, including pneumonia; once the person recovers, the infiltrates will often go away. In severe cases, though, a person may need to be placed on a mechanical ventilator to help with oxygenation and breathing.

What is Effusion?

Definition:

An effusion is an accumulation of extra fluid around the lungs and the membranes around the lungs. It is normal for there to be a small amount of fluid surrounding the membranes or pleura of the lungs, and it only becomes a problem when there is an excess quantity of fluid present.

Symptoms:

Symptoms of an effusion include being short of breath and having chest pain; pain is often worsened when the person lies down and a cough may also be present in some patients. Pain also is sharp and worsens when a person takes a breath.

Diagnosis:

A chest X-ray, CT scan or ultrasound can be used to detect and diagnose an effusion in the lungs. The effusion can be confused with an infiltrate but it is not actually within the lung tissue in the way that an infiltrate is. Analysis of the pleural fluid can help determine the cause of the effusion, which is important for determining the correct treatment options.

Causes and complications:

There are many reasons why an effusion may develop in the chest but the most common reason for an effusion to develop is congestive heart failure, resulting in an incorrect fluid balance in the lungs. Other causes include cirrhosis of the liver, open heart surgery complications, pulmonary embolism, tuberculosis, pneumonia, or kidney disease. An effusion often indicates an inflammatory response due to infection or compromised organs. An effusion is dangerous and leads to death in about 15% of afflicted patients.

Treatment:

A pleural effusion can be treated with diuretics, especially in a person who has congestive heart failure. In some cases, a thoracentesis is warranted in which fluid is drawn off the lungs using a needle. Antibiotic treatment is helpful when the condition is caused by a bacterial infection.

Difference between Pulmonary infiltrate and Effusion?

Definition

A pulmonary infiltrate is when there is a substance in the lungs such as pus or blood that is not meant to be present. An effusion is when there is an excess of fluid that has accumulated between the pleural membranes surrounding the lungs.

Involves pleura

The pleura are not involved in a pulmonary infiltrate. The pleura of the lungs are involved in the case of an effusion.

Causes

Pneumonia, heart failure, lung fibrosis, tuberculosis, HIV, and ARDs are some of the causes of pulmonary infiltrates. Congestive heart failure, complications from heart surgery, pneumonia, kidney disease, tuberculosis, and pulmonary embolism are some reasons why a person develops an effusion.

Diagnosis

A chest X-ray, CT scan, and MRI are used for diagnosing a pulmonary infiltrate. A chest X-ray, CT scan, and ultrasound are often used to diagnose an effusion.

Treatment

The treatment for pulmonary infiltrate includes antibiotics or other antimicrobial therapy. The treatment for an effusion includes the use of diuretics, antibiotics, and sometimes a thoracentesis.

Table comparing Pulmonary infiltrate and Effusion

Summary of Pulmonary infiltrate Vs. Effusion

  • An infiltrate and effusion can both affect a person’s breathing ability.
  • The pulmonary infiltrate is when there is some substance in the lung tissue itself which is not supposed to be present.
  • The effusion impacts the lungs indirectly and is when there is too much fluid between the membranes and the lungs.
  • Lung infections can cause a pulmonary infiltrate or an effusion to occur.
  • A pulmonary infiltrate or an infusion can be due to an underlying illness such as tuberculosis or pneumonia.

Dr. Rae Osborn

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References :


[0]Danés, Cristina, et al. "Pulmonary infiltrates in immunosuppressed patients: analysis of a diagnostic protocol." Journal of clinical microbiology 40.6 (2002): 2134-2140.

[1]Light, Richard W. “Pleural Effusion”. Merckmanuals, Merck & Co., 2019, https://www.merckmanuals.com/professional/pulmonary-disorders/mediastinal-and-pleural-disorders/pleural-effusion

[2]Rocco, M., et al. "Diagnostic accuracy of bedside ultrasonography in the ICU: feasibility of detecting pulmonary effusion and lung contusion in patients on respiratory support after severe blunt thoracic trauma." Acta anaesthesiologica scandinavica 52.6 (2008): 776-784.

[3]Image credit: https://commons.wikimedia.org/wiki/File:Pulmonary_oedema.jpg

[4]Image credit: https://upload.wikimedia.org/wikipedia/commons/thumb/4/48/Diagram_showing_a_build_up_of_fluid_in_the_lining_of_the_lungs_%28pleural_effusion%29_CRUK_054.svg/500px-Diagram_showing_a_build_up_of_fluid_in_the_lining_of_the_lungs_%28pleural_effusion%29_CRUK_054.svg.png

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