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Respiratory > 2: Pleural Effusion > Flashcards

2: Pleural Effusion Flashcards

1
Q

What is a pleural effusion

A

Fluid in pleural space

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2
Q

How are effusions divided

A

Into either exudates or transudates depending on protein content

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3
Q

What is an exudate

A

Protein >30g/L

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4
Q

What are the 4 etiological categories of exudate

A
  • Infectious
  • Malignant
  • Autoimmune
  • Other
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5
Q

What 3 infections can cause exudate

A

Pneumonia
TB
Empyema

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6
Q

What malignancies can cause exudate

A

Primary lung
Mets
Lymphoma
Mesothelioma

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7
Q

What are 4 autoimmune causes of exudate

A

RA
Sarcioidosis
SLE
Vasculitis

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8
Q

What are 4 other causes of exudate

A

PE
Haemothorax
Chylothorax
Pancreatitis

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9
Q

What is a transudate

A

Protein content less than 30g/L

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10
Q

What are the 3 etiological categories of transudates

A
  • Increase venous pressure
  • Protein deficiency
  • Other
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11
Q

What are 3 causes of increase venous pressure

A

HF
Constrictive pericarditis
Fluid Overload

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12
Q

What are 3 causes of protein deficiency

A

Cirrhosis
Protein-losing enteropathy
Nephrotic syndrome

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13
Q

What are 2 other causes of transudate

A

Hypothyroidism

Meig’s syndrome

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14
Q

What is Meig’s syndrome

A

Ovarian fibroma and right pleural effusion

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15
Q

What defines a small pleural effusion

A

Less than 200ml

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16
Q

How do small pleural effusions present

A

Asymptomatic

17
Q

How do large pleural effusions present

A
  • Dyspneoa
  • Pleuritic chest pain
  • Dry non-productive cough
18
Q

Why do large pleural effusions cause dyspneoa

A

Compress lung

19
Q

In large effusions, explain position trachea

A

Will be deviated away from the lesion

20
Q

What is first-line investigation for pleural effusion

A

PA CXR

21
Q

When can pleural effusion only be seen on CXR

A

> 600ml

22
Q

How does pleural effusion present on CXR

A
  • Blunting costophrenic or cardiophrenic angle
  • Fluid in horizontal or oblique fissures
  • Visible meniscus
  • Mediastinal shift away from side affected - if large
23
Q

What is second-line for pleural effusion

A

US-Guided needle aspiration

24
Q

What criteria may be used to evaluate pleural effusion

A

Light’s Criteria

25
Q

When is lights criteria used

A

If protein in fluid is borderline 25-35g/L

26
Q

What does lights criteria state

A

That if any of the following are present, the fluid is more likely a exudate than transudate:
1. Pleural protein/Serum protein >0.5

  1. Pleural LDH/Serum LDH >0.5
  2. Pleural LDH in upper 2/3rd of normal LDH
27
Q

What does low glucose in pleural fluid imply

A
  • TB

- RA

28
Q

What does raised amylase in pleural fluid indicate

A
  • Pancreatitis

- Oesophageal perforation

29
Q

What does blood stained pleural effusion indicate

A
  • TB
  • PE
  • Mesothelioma
30
Q

What is third-line investigation for pleural effusion

A

Contrast CT

31
Q

How are pleural effusions managed

A

Treat cause

May use chest drain

32
Q

What are 3 indications for placing a chest tube in pleural effusion

A
  1. Cloudy fluid
  2. pH less than 7.2
  3. Symptomatic
33
Q

At what rate should fluid be removed from chest tube in pleural effusion

A

1.5L per 24h

34
Q

What are methods to manage recurrent pleural effusions

A
  • Recurrent aspiration
  • Pleurodesis
  • Indwelling catheter
  • Opioids to relieve breathlessness

Respiratory (19 decks)

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