Pleural Disease

Question 1

Symptoms of a pleural effusion

Answer 1

• Asymptomatic
• Shoulder pain/ heaviness
• Dry cough
• Pleuritic pain
• Breathlessness

Question 2

Signs of a pleural effusion

Answer 2

• Reduced vocal fremitus
• Stony dull on percussion
• Deviation of the trachea
• Reduced breath sounds

Question 3

What can causes

a) exudate
b) transudate

Answer 3

Exudate: rises from an inflammatory process making the vessels more permeable. Infection, mesothelelioma, malignancy, TB
Transudate: rises from differences in pressure difference. Liver disease, dialysis, nephrotic syndrome

Question 4

How do you tell apart exudate and transudate

Answer 4

Stage 1: protein content
>30g/L= exudate, <30g/L= transudate
Stage 2: If this is unclear use the lights criteria. The fluid is exudate if: 
- Fluid protein: serum protein >0.5
- Fluid LDH: Serum LDH> 0.6

Question 5

Is the pH likely to be low or high in exudate

Answer 5

Low

Question 6

Is the glucose likely to be low or high in exudate

Answer 6

Low

Question 7

What is seen on a chest x-ray

Answer 7

• Effusion

- Loss of costophrenic angle

Question 8

Does an exudate appear clear or cloudy

Answer 8

Cloudy

Question 9

Where should you aspirate

Answer 9

In the ‘safe’ zone

Over the top of the rib to avoid the Neurovascular bundle

Question 10

When should chest tube be placed (3)

Answer 10

• If the sampled fluid is cloudy/ turbid
• If cultures establish an infection
• If pH <7.2