17. Pleural effusion

Question 1

What is a pleural effusion

Answer 1

collection of fluid in the pleural cavity

Question 2

What is the difference in protein count between exudative and transudative pleural effusions

Answer 2

exudative has high protein count (less than 3)

transudative is relatively lower protein count

Question 3

Describe what an exudative cause of pleural effusion is

Answer 3

related to inflammation

results in protein leaking out of the tissues into the pleural space (Ex- meaning move out)

Question 4

name some causes of exudative pleural effusion causes (think inflammation)

Answer 4

lung cancer
pneumonia
rheumatoid arthritis
tuberculosis

Question 5

describe what a transudative cause of pleural effusion is

Answer 5

relates to fluid moving across into the pleural space (trans- means moving across)
- think of the 3 main organs, CCF, cirrhosis and nephrosis

Question 6

name some causes of tranudative pleural effusion (think of fluid shifting)

Answer 6

Congestive cardiac failure
Hypoalbuminaemia
Hypothroidism
Meig’s syndrome (right sided pleural effusion with ovarian malignancy

Question 7

how does someone with pleural effusion present

Answer 7

SOB
Dullness to percussion over the effusion
reduced breath sounds
tracheal deviation away from the effusion if it is massive

Question 8

what would a chest x ray show in someone with a pleural effusion

Answer 8

blunting of costophrenic angles
fluid in the lung fissures
larger effusions will have a meniscus
tracheal and mediastinal deviation if it is a massive effusion

Question 9

Apart from a CXR what other investigations can be done

Answer 9

taking a sample of the pleural fluid by aspiration or chest drain

Question 10

what is the treatment for pleural effusion

Answer 10

conservative management as small effusions will resolve with treatment of the underlying cause
larger ones will need aspiration or draining

Question 11

What is empyema and when should it be suspected

Answer 11

infected pleural effusion

pt who has improving pneumonia but new or ongoing fever

Question 12

what does the pleural aspiration show in empyema

Answer 12

acidic PH
low glucose
high LDL

Question 13

main causes of transudate pleural effusion

Answer 13

CHF
cirrhosis
nephrotic syndrome
PE

Question 14

main causes of exudative pleural effusion

Answer 14

malignancy 
bacterial/viral pneumonia 
TB
PE
pancreatitis 
oesophageal rupture