Pleural Effusion

Question 1

What is a pleural effusion?

Answer 1

Fluid collection between the parietal and visceral pleural surfaces of the thorax.

Question 2

What is the aetiology of a transudative pleural effusion?

Answer 2

Increased hydrostatic pressure or decreased oncotic pressure.

Question 3

What is the aetiology of exudative pleural effusion?

Answer 3

Increase in capillary permeability or decreased pleural fluid reabsorption. Usually secondary to infection, inflammation or malignancy.

Question 4

What is this a presentation of?
Pneumonia/malignancy/CHF, dyspnoea, dullness to percussion, pleuritic chest pain, cough, quieter breath sounds, decreased fremitus.

Answer 4

Pleural effusion

Question 5

How is a suspected pleural effusion investigated?

Answer 5

1. PA CXR
2. Routine bloods if Hx suggests infection
3. Thoracentesis under USS to identify and diagnose cause (except in known/evident heart failure).

Question 6

What is the management of a pleural effusion in these scenarios?

1. Large, symptomatic effusion
2. Congestive heart failure
3. Infection
4. Malignancy

Answer 6

1. Give O2 and drain slowly
2. Loop diuretics initially
3. Antibiotics and drain if fluid not resolving
4. Drain (usually reoccurs), thoracentesis or chest drain.