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
causes
Haemothorax:
*
when the fluid is blood
- Trauma
- After pleural aspiration
- Red
causes Chylothorax
when the fluid is lymph (e.g. leak from lymphatic duct
- Trauma
- After pleural aspiration
- Cloudy
causes of Empyema
when fluid is pus
- infective cause
-
After pleural aspiration
-
Hard to tell
- Send fluid off for:
- Protein levels
- Glucose levels
- LDH (lactate dehydrogenase)
- MC and S
- pH <7
- Send fluid off for:
-
Hard to tell
Treatment
- Depending on the cause
- In very symptomatic pts: chest aspiration
- Recurrent effusions (particularly malignant) may require
Indwelling pleural catheter (IPC) for intermittent drainage
Pleurodesis
Aim to allow adequate oxygenation of the lungs for the rest of the body
Pleurodesis
obliteration of the pleural space
main causes of transudate in simple efussion
congestive cardiac failure
- Hypoproteinaemia
- Nephrotic syndrome
- Liver cirrhosis
main causes of exudate in simple efussion
infection (TB, pneumonia), lung malignancy, pulmonary infarction
lights criteria of transudate vs exudate
In general….Transudate
- reduced protein (albumin
- Reduced oncotic pressure
- More water leaks out of capillaries and into potential spaces such as pleural cavity
In general…. Exudate
- normal protein (albumin)
- Protein’s molecules pass through leaky capillary
- Due to inflammation
