2: Pleural Effusion Flashcards
What is a pleural effusion
Fluid in pleural space
How are effusions divided
Into either exudates or transudates depending on protein content
What is an exudate
Protein >30g/L
What are the 4 etiological categories of exudate
- Infectious
- Malignant
- Autoimmune
- Other
What 3 infections can cause exudate
Pneumonia
TB
Empyema
What malignancies can cause exudate
Primary lung
Mets
Lymphoma
Mesothelioma
What are 4 autoimmune causes of exudate
RA
Sarcioidosis
SLE
Vasculitis
What are 4 other causes of exudate
PE
Haemothorax
Chylothorax
Pancreatitis
What is a transudate
Protein content less than 30g/L
What are the 3 etiological categories of transudates
- Increase venous pressure
- Protein deficiency
- Other
What are 3 causes of increase venous pressure
HF
Constrictive pericarditis
Fluid Overload
What are 3 causes of protein deficiency
Cirrhosis
Protein-losing enteropathy
Nephrotic syndrome
What are 2 other causes of transudate
Hypothyroidism
Meig’s syndrome
What is Meig’s syndrome
Ovarian fibroma and right pleural effusion
What defines a small pleural effusion
Less than 200ml
How do small pleural effusions present
Asymptomatic
How do large pleural effusions present
- Dyspneoa
- Pleuritic chest pain
- Dry non-productive cough
Why do large pleural effusions cause dyspneoa
Compress lung
In large effusions, explain position trachea
Will be deviated away from the lesion
What is first-line investigation for pleural effusion
PA CXR
When can pleural effusion only be seen on CXR
> 600ml
How does pleural effusion present on CXR
- Blunting costophrenic or cardiophrenic angle
- Fluid in horizontal or oblique fissures
- Visible meniscus
- Mediastinal shift away from side affected - if large
What is second-line for pleural effusion
US-Guided needle aspiration
What criteria may be used to evaluate pleural effusion
Light’s Criteria
When is lights criteria used
If protein in fluid is borderline 25-35g/L
What does lights criteria state
That if any of the following are present, the fluid is more likely a exudate than transudate:
1. Pleural protein/Serum protein >0.5
- Pleural LDH/Serum LDH >0.5
- Pleural LDH in upper 2/3rd of normal LDH
What does low glucose in pleural fluid imply
- TB
- RA
What does raised amylase in pleural fluid indicate
- Pancreatitis
- Oesophageal perforation
What does blood stained pleural effusion indicate
- TB
- PE
- Mesothelioma
What is third-line investigation for pleural effusion
Contrast CT
How are pleural effusions managed
Treat cause
May use chest drain
What are 3 indications for placing a chest tube in pleural effusion
- Cloudy fluid
- pH less than 7.2
- Symptomatic
At what rate should fluid be removed from chest tube in pleural effusion
1.5L per 24h
What are methods to manage recurrent pleural effusions
- Recurrent aspiration
- Pleurodesis
- Indwelling catheter
- Opioids to relieve breathlessness
