What would a pleural effusion on the left side typically present with on the left chest: decreased breath sounds, egophony, whispered pectoriloquy, crackles, or hyperresonance?

From the Guidelines

A pleural effusion on the left side would typically show decreased breath sounds on examination of the left chest. When fluid accumulates in the pleural space between the lung and chest wall, it creates a barrier that dampens the transmission of breath sounds through the chest wall. This physical finding occurs because sound waves must travel through the fluid collection, which absorbs and attenuates them before they reach the stethoscope. The other findings mentioned would not typically be present with a pleural effusion. Egophony (E-to-A changes) and whispered pectoriloquy are actually signs of lung consolidation, not fluid. Crackles suggest fluid within the airways or alveoli rather than the pleural space. Hyperresonance indicates increased air (as in emphysema or pneumothorax), which is the opposite of what occurs with fluid accumulation. The decreased breath sounds in pleural effusion may be accompanied by dullness to percussion over the affected area, which further helps distinguish it from other pulmonary conditions. According to the British Thoracic Society guideline for pleural disease 1, a careful history and physical examination of the patient remains the most important first step when evaluating someone with an undiagnosed pleural effusion.

Some key points to consider when evaluating a patient with a pleural effusion include:

• The patient’s drug history should always be recorded, as a number of medications have been reported to cause exudative pleural effusions 1
• A detailed occupational history, including any previous asbestos exposure is also vital information when investigating all pleural effusions 1
• Thoracic ultrasound (TUS) is now an extension of the physician’s arm and has never been as important, both as a diagnostic tool and to improve the safety of invasive procedures 1
• The management of malignant pleural effusions should aim to relieve dyspnea in a minimally invasive manner, and ideally minimize repeated procedures and interaction with the healthcare system 1

In terms of diagnosis and management, decreased breath sounds are a key finding in pleural effusion, and can be used to distinguish it from other pulmonary conditions. The use of thoracic ultrasound and other diagnostic tools can help to confirm the diagnosis and guide treatment. According to the American Thoracic Society guidelines for the management of malignant pleural effusions 1, treatment should aim to provide a definitive pleural intervention, and can include techniques such as thoracoscopy and placement of indwelling pleural catheters (IPCs).

From the Research

Physical Examination Findings

• Decreased breath sounds: A pleural effusion on the left side would likely show decreased breath sounds on the left chest, as the fluid accumulation in the pleural space can dampen the sound of breathing 2, 3.
• Egophony: This is a physical examination finding where the sound of the patient's voice is amplified and has a hollow, echoing quality when heard through a stethoscope. Egophony can be present in cases of pleural effusion, particularly when the effusion is large enough to cause significant lung compression 2.
• Whispered pectoriloquy: This is another physical examination finding where the sound of a whispered voice is easily heard through a stethoscope. Whispered pectoriloquy can be present in cases of pleural effusion, particularly when the effusion is large enough to cause significant lung compression 2.
• Crackles: Crackles are a type of lung sound that can be heard through a stethoscope and are often associated with lung diseases such as pneumonia or interstitial lung disease. While crackles can be present in cases of pleural effusion, they are not a specific finding for this condition 4, 5.
• Hyperresonance: Hyperresonance is a physical examination finding where the chest sounds more resonant than normal when tapped. This is typically associated with conditions such as pneumothorax, where air accumulates in the pleural space, rather than pleural effusion, where fluid accumulates 5, 6.

Summary of Findings

Based on the available evidence, a pleural effusion on the left side would most likely show decreased breath sounds, egophony, and whispered pectoriloquy on the left chest. Crackles may also be present, but are not specific to pleural effusion. Hyperresonance is less likely to be present in cases of pleural effusion.