Pleural Effusion Flashcards
1
Q
What is a pleural effusion?
A
fluid in the pleural space
2
Q
What are the two types of pleural effusion?
A
exudates and transudates
3
Q
What is the name given to blood in the pleural space?
A
haemothorax
4
Q
What is pus in the pleural space?
A
pyema
5
Q
What is chyle (lymph with fat) in the pleural space?
A
chylothorax
6
Q
What is the mechanisms that cause transudates
A
increased venous pressure - cardiac failure - constrictive pericarditis - fluid overload Hypoproteinaemia - cirrhosis, nephrotic syndrome, malabsorption Hypothyroidism Meig's syndrome
7
Q
What can cause exudates?
A
- Mostly due to increased leakiness of pleural capillaries secondary to infection, inflammation or malignancy
- Causes: pneumonia, pulmonary infarction, rheumatoid arthritis, SLE, bronchogenic carcinoma, malignant metastases, lymphoma, mesothelioma, lymphangitis carcinomatosis
8
Q
What are the main symptoms of a pleural effusion?
A
- Asymptomatic
* Dyspnoea, pleuritic chest pain
9
Q
What are the main signs of a pleural effusion?
A
- Decreased expansion
- Stony dull percussion notes
- Diminished breath sounds
- Above the effusion: Where the lung is compressed, there may be bronchial breathing
- Large effusions: trachea may be deviated away from the effusion
10
Q
What are the main aspiration marks and signs of associated disease in a pleural effusion?
A
o Malignancy – cachexia, clubbing, lymphadenopathy, radiation marks, mastectomy scars o Stigmata of chronic liver disease o Cardiac failure o Hypothyroidism o Rheumatoid arthritis o Butterfly rash of SLE
11
Q
What would be observed on a CXR in a pleural effusion?
A
- Small effusions = blunt costophrenic angles
- Large effusions = water dense shadows with concave upper borders
- Completely flat horizontal line = also a pneumothorax present
12
Q
What are the main methods of management of a pleural effusion?
A
- Drainage – if it is symptomatic drain it
- Pleurodesis with talc may be helpful for recurrent effusions
- Intra-pleural alteplase and dornase alfa may help with empyema
- Surgery – persistent collet cions and increasing pleural thickness (on USS) requires surgery
