15. Pleural effusion

Question 1

What is a pleural effusion?

Answer 1

Fluid in the plural space.

Question 2

How can pleural effusions be classified?

Answer 2

By protein content

Those that contain under 25g/l are transudates

Those than contain over 35g/l are exudates

Question 3

What causes a transudate pleural effusion?

Answer 3

Increased venous pressure
Hypoproteinaemia
Hyperthyroidism

Question 4

What causes exudate pleural effusion?

Answer 4

Infection, inflammation, malignancy

Pneumonia, TB,
Pulmonary infarction, SLE, RA
lung cancer, lymphoma, mesothelioma

Question 5

What are the symptoms of a plueral effusion?

Answer 5

Asymptomic
Dyspnoea
Pleuritic chest pain

Question 6

What are the signs of a pleural effusion?

Answer 6

Stony dull percussion note
Decreased expansion
Decreased breath sounds and vocal resonance
Tracheal deviation (if big boy)
Looks for signs of associated disease (butterfly rash, clubbing)

Question 7

What tests should be done when looking for a pneumothorax?

Answer 7

CXR
USS
Diagnostic aspiration
Pleural biopsy

Question 8

What is involved in a diagnostic aspiration?

Answer 8

Pleural fluid is taken from one intercostal space below where it is percussed. 10-30ml are sampled and sent to the lab for

Clinical chemistry (protein, glucose, LDH)
Bacteriology (microscopy and culture)
Cytology
Immunology (rheumatoid factor, ANA complement)

Question 9

How is a pleural effusion managed?

Answer 9

Drainage- aspiration (slowly) or inercostal drain

Pleurodesis (seals lungs to walls)

Intra-pleural alteplase and dornase alfa

Surgery