Pleural Effusion

Question 1

What is a pleural effusion?

Answer 1

A collection of fluid in the pleural cavity

Question 2

Fluid in the pleural cavity can be categorised into two different types - what are these?

Answer 2

• Exudative = high protein count ( > 3g/L)

- Transudative = low protein count ( < 3g/L)

Question 3

What are the causes of exudative pleural effusion?

Answer 3

Caused by inflammation and increased permeability of capillaries/pleural surface:

• Lung cancer
• Pneumonia

Question 3

What are the causes of transudative pleural effusion?

Answer 3

Caused by disruption of normal hydrostatic/oncotic pressures:

• Congestive cardiac failure
• Hypoalbuminaemia
• Cirrhosis
• Meig’s syndrome (right sided pleural effusion with ovarian malignancy)

Question 3

Describe the clinical features of a pleural effusion

Answer 3

• Dyspnoea
• Cough
• Pleuritic chest pain
• Dullness to percussion over the effusion

Question 4

Describe the investigation of a suspected pleural effusion

What would you expect to find on imaging?

Answer 4

CXR:
- Blunting of the costophrenic angle
Fluid in the lung fissures

Taking a sample of pleural fluid:

• Pleural aspiration
• Chest drain

Question 5

Describe the management of pleural effusion

Answer 5

• Small effusions may resolve with treatment of the underlying cause
• Larger effusions may need draining (either via pleural aspiration or chest drain insertion)

Question 6

What is an empyema?

Answer 6

An infected pleural effusion

Question 7

Describe the management of an empyema

Answer 7

• Chest drain

- Antibiotics