OnlineMedEd: Pulmonology - "Pleural Effusion" Flashcards
Review the transudative pleural effusions.
Increased hydrostatic pressure:
•CHF
Decreased oncotic pressure:
•Nephrotic syndrome
•Kwashiorkor
•Liver disease
Review the exudative pleural effusions.
- Malignancy
- TB
- Pneumonia
What are signs of pleural effusion on chest x-ray?
- Blunting of the costophrenic angle (this indicates that the consolidation is outside of the lung)
- Consolidation over the lung parenchyma with a horizontal meniscus
Although CT and ultrasound can also detect pleural effusions, _______________ is the test of choice.
lateral decubitus x-ray
Define loculated.
Stuck in a pocket
In the case of a loculated pleural effusion, fluid is stuck in a pocket on the side of the lung –an indentation.
Do through the diagnosis and workup for pleural effusion.
•First, suspect pleural effusion in someone with distant breath sounds and dullness on percussion in the lower parts of the lungs.
• Second, do a chest x-ray.
- If they have CHF (evidenced by cardiomegaly), then the chance that the pleural effusion is from CHF is so high that you diurese and observe.
- If they have a small pleural effusion (less than 1 cm), then just watch and wait.
- If they have a large, loculated pleural effusion, then do a thoracostomy to test the fluid.
Describe the criteria that can determine exudate vs. transudate in a thoracentesis.
• Light’s criteria:
- LDH(f): greater than 2/3 upper limit of normal
- LDH(f)/LDH(s): greater than 0.6
- Total protein (f) / total protein (s): greater than 0.5
If any one of those is positive, then it is an exudate.
In addition to the labs in Light’s criteria, what should you test in a thoracentesis sample?
•Cell count
- PMNs = pneumonia; lymphs = TB/malignancy; RBCs = hemothorax
•Gram stain and culture
•Cytology (for malignancy)
•Triglycerides (for chylothorax)
•Adenosine deaminase (most sensitive test for TB)
