B4-026 CBCL Pleural Effusion Flashcards
studies ordered to determine if effusion is transudate or exudate
- serum and pleural fluid protein
- LDH
pleural fluid/serum fluid > 0.5
pleural fluid/serum LDH >0.6
exudate
appropriate treatment of empyema
antibiotics and surgical intervention
helps lungs expand and keeps them inflated
negative pressure in the pleural space
complications of thoracentesis
- pneumothorax
- hemothorax
- infection
- chest wall bleeding
- cough
- vasovagal syncope
low pleural pH
pleural glucose <60 mg/dl
exudate
quick, inexpensive way to determine if effusion is free flowing following PA chest
lateral decubitus CXR
extravascular in origin
chylothorax
impaired lymphatic drainage
malignancy
increased capillary permeability
parapneumonic effusions
transdiaphragmatic movement of fluid from peritoneal cavity
ascites
increased transplural pressure gradient
CHF
tests necessary prior to diagnostic thoracentesis
- CXR or ultrasound
- platelet count
- PTT
what should be the next step following recurrent pleural effusion with no known etiology?
thoroscopy or VATS
what test is helpful in establishing transudate?
NT-proBNP
what lab test would be helpful for establishing exudate?
- cultures
- CBC w/ diff
- glucose
- pH
start antibiotics […] thoracentesis
after
a lateral decubitus film can determine if the effusion is
free flowing
following PA chest, get what view?
lateral decubitus
pleural fluid glucose <60 is consistent with
exudate
pleural fluid ADA level >40 is consistent with
TB
if suspicion of PE is high but also exibiting pleural effusion what steps should be done first?
immediate anticoagulation, then CTA
mechanism of hypoxemia during pleural effusion
increased right to left intrapulmonary shunt
TG >110 mg/dl
chylomicrons present
chylothorax
TG <110
chylomicrons absent
empyema
complication of surgical repair of thoracic aortic aneurysm
post operative chylothorax
associated with pus, but not an elevated TG level
empyema
usual mechanism associated with malignancy
impaired lymphatic drainage
mechanism associated with parapneumonic effusion
increased capillary pressure
test best used to search for malignant cells
PF cytology
NT-proBNP is helpful if you suspect
CHF
most helpful test in establishing transudate vs exudate
pleural fluid protein:serum protein
ratio
what is the most common cause of pleural effusion in the US?
CHF
treatment for empyema
antibiotics
thoroscopy/VATS
effusions associated with peritoneal dialysis are typically
transudate
causes of transudate
3
CHF
cirrhosis
nephrotic syndrome
causes of exudate
4
- infection
- malignancy
- chylothorax
- trauma
pleural fluid protein: serum protein
is >0.5
exudate
fluid LDH: serum LDH
is > 0.6
exudate
pleural fluid LDH > 2/3 normal
exudate
