Pleural Disease Flashcards
What is pleural effusion?
Excess fluid in the pleural space
Pleural effusion can lead to various respiratory symptoms and complications.
Define empyema.
Infected pleural effusion
Empyema often requires drainage and antibiotic treatment.
What characterizes a transudate pleural effusion?
Low protein (<30), Low LDH, bilateral pleural effusion
Transudates are often caused by systemic factors affecting fluid balance.
List conditions that can cause transudate.
- Heart failure (HF)
- Liver failure (LF)
- Nephrotic syndrome
- Hypoalbuminemia
- Malabsorption
- Hypothyroidism
These conditions disrupt hydrostatic and oncotic pressures.
What is the treatment approach for transudate?
Treat the underlying cause
Addressing the primary condition often resolves the pleural effusion.
What characterizes an exudate pleural effusion?
High protein (>30), high LDH, unilateral
Exudates are typically due to localized processes affecting pleural fluid. E.g. hgh proteins int he lngs due to pneumonia infection/inflammation.
List conditions that can cause exudate.
- Infections (e.g., pneumonia, TB)
- Cancer (e.g., lung cancer, mesothelioma)
- Connective tissue disease (e.g., RA, SLE)
- Pancreatitis
- Esophageal rupture
- Pulmonary embolism (PE)
- Dressler’s syndrome
These conditions often increase capillary permeability or decrease lymphatic drainage.
What is the treatment approach for exudate pleural effusion?
Treat with chest drain
Drainage helps relieve symptoms and prevent complications.
What does a pleural effusion fluid protein/serum protein ratio >0.5 indicate?
The effusion is an exudate
This criterion assists in differentiating between transudate and exudate.
What are the three types of fluid that can be present in the pleural space?
- Haemothorax (blood)
- Empyema (pus)
- Chylothorax (chyle)
All three conditions typically require chest drainage and repair.
What are common symptoms of pleural effusion?
- Dyspnea
- Non-productive cough
- Chest pain
Symptoms may vary based on the volume and cause of the effusion.
What are signs of pleural effusion upon examination?
- Dullness to percussion
- Reduced breath sounds
- Reduced chest expansion
These signs help in clinical assessment of pleural effusion.
What is LIGHT’S CRITERIA used for?
To decide treatment for pleural effusions with protein levels between 25-35g/L
It helps determine if the effusion should be treated as an exudate.
What bedside investigations are performed for pleural effusion?
- Respiratory/cardiovascular exam
- Urine dip (nephrotic syndrome)
- ECG
These assessments help identify underlying conditions contributing to the effusion.
What blood tests are relevant for diagnosing pleural effusion?
- FBC (Hb, WBC)
- CRP
- LFTs (liver failure)
- BNP (heart failure)
- U&Es
- Clotting
These tests provide insight into systemic conditions that may cause pleural effusion.
What imaging studies are used to assess pleural effusion?
- CXR
- USS (before chest drain)
Imaging helps visualize the effusion and its characteristics.
What are CXR signs of pleural effusion?
- Blunting of costophrenic angles
- Meniscus signs
- Tracheal/mediastinal deviation
Requires >200ml of fluid for detection on PA films.
What does the color of pleural aspirate indicate?
- Straw colored - normal
- Blood stained - mesothelioma, PE, TB
- Purulent/turbid - empyema
- Milky/chylous - chylothorax
- Black - Aspergillus
The color can suggest specific underlying conditions.
What does low glucose in pleural fluid suggest?
Rheumatoid arthritis (RA), tuberculosis (TB)
Low glucose levels can indicate inflammatory processes.
What does raised amylase in pleural fluid indicate?
Pancreatitis, esophageal perforation
Elevated amylase levels suggest certain pathological conditions affecting the pleura.
What pH level in pleural fluid indicates a pleural infection?
pH < 7.2
This finding necessitates placement of a chest tube and antibiotics.
What is the managing pleural effusion?
Thepapeutic pleural aspiration
Addressing the cause can help resolve the effusion and symptoms.
What medical treatments are used for pleural effusion?
- Diuretics (for heart failure)
- Antibiotics (for infection)
These medications target the underlying issues contributing to the effusion.
What is the intervention for pleural effusion?
- Therapeutic pleural aspiration
- Chest drain insertion (NOT in bilateral)
This procedure can relieve symptoms and analyze pleural fluid.
