Pleural Disease

Question 1

What is a pleural effusion?

Answer 1

Abnormal collection of fluid in the pleural space

Question 2

What is mesothelioma and what is a common presenting symptom? What is it linked to?

Answer 2

• Malignant tumour of the lining of the lung or very occasionally of the lining of the abdominal cavity.
• One of the presenting symptoms is pleural effusion.
Linked to asbestos exposure but can take 30-40 years to develop.

Question 3

Treatment options for pleural effusion?

Answer 3

Talc

Long term pleural catheter

Question 4

What antibiotics should you avoid in pleural infection?

Answer 4

Amino glycosides (particularly gentamicin) as these have poor pleural penetration.

Question 5

What are the three stages of effusions and what are test results?

Answer 5

Simple
clear fluid, pH more than 7.2,glucose more than 2.2 and LDH less than 1000

Complicated
ph less than 7.2, glucose less than 2.2 and LDH more than 1000.

Empyema- frank pus and no more tests are needed

Question 6

A pleural effusion can be detected on X ray when more than _____ of fluid is present and detected clinically when more than _____ of fluid is present

Answer 6

300 ml

500 ml

Question 7

What are some causes of transudative pleural effusion?

Answer 7

PROBLEM WITH PRESSURE
Nephrotic syndrome
Heart Failure 
Cirrhosis 
Constrictive pericarditis

Question 8

What are some causes of exudative pleural effusions?

Answer 8

INFLAMMATORY RESPONSE LEAKY VESSELS
Infection
Cancer
Systemic Inflammatory condition e.g. SLE 
Trauma

Question 9

Protein > 30 g/L

LDH > 200 IU/L

Answer 9

Exudate

Question 10

Protein < 30 g/L

LDH < 200 IU/L

Answer 10

Transudate

Question 11

Lights criteria for an exudative pleural effusion?

Answer 11

• Pleural fluid protein: serum protein > 0.5
• Pleural fluid LDH: serum LDH > 0.6
• Pleural fluid LDH > 2/3 upper limit of normal for serum