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Pleural effusion: why we need to diagnose it earlier

Pleurisy is an inflammatory condition in pulmonology, with more than 50 recognized causes, including pleural or lung lesions, systemic diseases, organ dysfunction and medication. Pleural effusion represents the abnormal accumulation of fluid in the space between the lungs and the rib cage, called the pleural space. Normally, this area contains only a thin amount of fluid, which aids the movement of the lungs during breathing. 

Pathologically, pleural fluid may come from the pleural blood vessels, the pulmonary tissue, or the peritoneal cavity through small holes in the diaphragm. Accumulation of substance can be due to several causes, often being caused by inflammatory sources or due to changes in hydrostatic (created by liquid) and osmotic (created by particles) pressure.  

What is pleural effusion?

In short, pleural effusion is formed either when there is an excess of production or when there is a deficit of absorption in a region. Transudative pleural effusion is caused by fluid leaking into the pleural space. This is from increased pressure in the blood vessels or a low blood protein count. The most common causes for this situation are congestive heart failure, liver cirrhosis or nephrotic syndrome.  

Exudative effusion is caused by blocked blood vessels or lymph vessels, inflammation, infections or lung injury. In this case, the most common diseases that cause pleural effusion are tumors and metastases, tuberculosis, pneumonia, pulmonary embolism or pancreatitis. 

Other less common causes of pleural effusion include: 

The symptoms of pleurisy

The symptoms of pleurisy do not depend on the type of fluid found in the pleural space. The main manifestations that the patient feels are chest pain and dyspnea. 

The pain can range from mild to unbearable. This occurs because the pleural lining of the lung is irritated and is exacerbated by respiratory movements and coughing. It can be reduced by hand compression of the chest wall. 

Dyspnea or shortness of breath is another common symptom and can be caused voluntary, by shallow breathing due to pain or involuntary, due to compression of the fluid over the lung. Other symptoms may include cough, fever, rapid breathing and hiccups. 

Following the examination of a specialist, when a person has pleurisy, certain changes can be observed. These are represented by the following: 

  • Chest asymmetry and decreased range of respiratory movements in the affected region 
  • Decreased transmission of vibrations and sounds through the chest tissue in the region where the fluid is found 
  • Direct observation of the amount of fluid using imaging methods such as ultrasound, radiography or computed tomography 

The severity of pleural effusion is determined by the original cause, whether breathing is compromised, and whether it can be adequately treated. Infections caused by a virus, pneumonia, or heart failure are all causes of pleural effusion that can be efficiently treated or controlled. Treatments for concomitant mechanical difficulties, as well as treatment for the primary cause of the pleural effusion, are two aspects to consider. 

Because pleurisy directly affects breathing, it can cause serious complications. These include the following: 

  • Impaired lung function by preventing it from expanding 
  • If the fluid has been present for a long time, lung scarring and a permanent reduction in lung function may occur 
  • Liquid that stays in the body for a long time might become infected and create an abscess known as empyema 
  • Pneumothorax 

How is it diagnosed by doctors?

In order for the fluid to be removed and the risk of complications to decrease, it must first be located by a medical specialist. The quickest and easiest scan in this case is the X-ray.  

Most often, pleural effusion can be seen as a dense opacity with a starting point in the angle between the ribs and the diaphragm. The upper edge of the fluid has a concave appearance and depending on the amount of fluid it can push the lung to the opposite side. There are situations in which the liquid is concentrated in certain spaces, forming spindle-shaped collections. 

Due to the multitude of forms in which it can occur and the therapeutic urgency it presents, it is recommended that the pleural effusion is diagnosed as soon as possible. 

How do XVision algorithms work?

This is where XVision AI intervenes, the next step in medical imaging. Our software supports professionally qualified radiologists and clinicians when diagnosing a chest radiography, by detecting abnormal chest X-ray pathologies. 

We aid in obtaining a faster diagnosis by providing deep neural networks trained on a large collection of chest radiographies. It contains 3 different algorithms that serve different functions: 

1) A chest X-ray screening algorithm that is specifically trained and optimized to differentiate between normal and abnormal chest radiographies, regardless of the pathology encountered in the medical image. Its main use is to help radiologists in prioritizing their workload.

2) A chest X-ray pathology detection algorithm that can detect over 100 pathologies that are classified in 17 different classes of pathologies that include most of the existing chest radiological findings. It also generates a bounding box for each class of pathologies detected on the x-rays.

This way it emphasizes the areas that are considered anomalous by the algorithm, as well as an automated calculation of the cardio-thorax index. This helps identifying missed pathologies by prompting the user to not skip underreported medical findings.

3) A bone subtraction and suppression algorithm that generates two additional x-ray visualizations of the original chest radiography. The bone suppressed visualization emphasizes the bone tissue in the image, making it much easier for our users to spot fractures or calcifications. The bone subtracted one only shows soft tissue, increasing the visibility of lesions that hide behind bones.

Our seamless integration allows the user to view the analyzed images directly in their PACS screen, without the use of an external application. XVision’s algorithms provide radiologists with a way to prioritize and triage patients better, while making them more effective. 

Using XVision, a doctor can decrease the total time to diagnose each patient, as well as increase the precision of X-ray interpretation, especially during night shifts or during periods of time with increased workloads. 

Our team is dedicated to creating the best digital radiology system for medical imaging interpretation. All of them powered by AI.   

We are XVision.  

You can also read about how XVision is helping lung cancer detection  by clicking here.

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