Lecture 17- Pleural effusion Flashcards
In normal pleural cavity there is tightly controlled
production and absorption of pleural fluid.
pleural cavity lined by
mesothelial cells
pleural fluid is absorbed by the
lymphatic stoma
- Excess fluid in the pleural cavity
Imbalance between rate of production and absorption
types of pleural effusion
- simple effusion
- haemothorax
- chylothorax
- empyema
Simple effusion:
when there is fluid in the pleural fluid- can be transudate or exudate
transudate
occurs due to icnrease hdyrostatic pressure and low onctoic pressure
i.e. low protein and LDH
exudate
occurs due to ifnlamamtiona nd icnreased capillary permeability
i.e. fluid is high protein and LDH
Haemothorax: §
when the fluid is blood e.g. trauma
Chylothorax:
when the fluid is lymph (e.g. leak from lymphatic duct)
Empyema:
when the fluid is pus (secondary to resistant infection)
Presenting symptoms and signs
*
- SOB (gradual onset)
- Pleuritic chest pain – irritation of pleural lining to the fluid e.g. blood or lymph
- Features of clinical disease
- Congestive cardiac failure – pulmonary oedema
- Lung malignancy
Signs
- Trachea deviation
- Away from the affected side
- Chest movement
- Reduced on affected side
- Percussion notes
- Stony dull on affected side
- Breath sounds
- (Vesicular) reduced/ absent on affected side
- Vocal resonance
- Reduced on affected side
radiological findings: CXR and CT
Meniscus showing fluid in the pleural cavity (right base)
- Beneath the yellow line= fluid
causes of a simple effusion
- Pleural fluid
- Transudate or exudate
- Investigations
-
Pleural aspiration
- USS guided procedure
- Pleural fluid should be colourless
-
Pleural aspiration
lights criteria of transudate vs exudate
