11. Pleural effusions Flashcards
define pleural effusion - what are the 4 different types
collection of fluid in pleural space 1. haemothorax (blood) 2. chylothorax (chyle) 3. empyema (pus) 4. simple effusion
what are the 2 types of simple effusion and how are these different. which is more likely involved in bilateral effusion
- transudate - low protein content (<3.0g/dL) 2. exudate - high protein content (>3.0g/dL) transudate more likely involved in bilateral effusion as involves systemic causes
explain the main causes of transudate simple effusions
caused by decreased fluid reabsorption: - increased pleural cavity hydrostatic pressure, e.g. congestive cardiac failure - decreased capillary oncotic pressure, i.e. hypoalbuminaemia, e.g. cirrhosis, nephrotic syndrome
explain the main causes of exudate simple effusions
caused by fluid overproduction due to increased capillary permeability (e.g. in inflammation) 1. bronchial carcinoma 2. infection - pneumonia or TB 3. pulmonary infarction caused by PE
suggest 2 symptoms of pleural effusion
- gradual dyspnoea, esp. orthopnoea 2. cough
describe 3 possible signs of pleural effusion
- stony dullness on percussion 2. decreased chest wall movements 3. decreased breath sounds on auscultation
what characteristics on this X-ray are suggestive of pleural effusion
- uniform white area
- minicus sign
- blunting of costophrenic angle
- hemidiaphragm obscured
(+/- mediastinal shift away if large effusion)
which diagnostic test should be performed as well as X-ray in pleural effusion
diagnostic pleural aspiration: removal (under US guidance) and analysis of the fluid for protein content, bacterial examination and culture (gram stain) and cytology.
describe the management of pleural effusion
- treatment of underlying cause
- +/- therapeutic drainage of large symptomatic pleural effusions
