Pleural effusion

Question 1

What is the criteria used to determine if an effusion is transudative or exudative if protein levels are between 25 and 35g/L?

Answer 1

Light’s criteria

Question 2

What are some causes of transudative effusions?

Answer 2

Mnemonic: CHARM

C CF
H ypoalbuminaemia
A scites
R enal failure
Meig's syndrome

Question 3

What are some causes of exudative effusions?

Answer 3

Mnemonic: PINTS

P neumonia
I nfection
N eoplasm
T uberculosis
S LE/other CTD/Rheumatoid Arthritis

Question 4

List some causes of lung abscesses?

Answer 4

SOAP

Mnemonic: SOAP

Septic emboli
Obstruction (i.e., foreign body, tumor)
Aspiration (i.e., alcohol, bulbar palsy, achalasia)
Pulmonary infarct/Pneumonia

Question 5

Give 4 findings on auscultation of a pleural effusion

Answer 5

Reduced breath sounds
Crackles above the effusion (parapneumonic effusion)
Reduced vocal resonance (fluid prevents sound transmission)
Bronchial breath sounds above the effusion

Question 6

Give 4 findings on examining the chest of a pleural effusion

Answer 6

Reduced chest expansion
Stony dull percussion note
Reduced breath sounds
Reduced vocal resonance
Reduced tactile fremitus

Question 7

Give the details of Light’s criteria

Answer 7

Exudative:

1) Pleural/serum protein ratio >= 0.5
2) Pleural/serum LDH ratio >= 0.6
3) Pleural LDH >= 2/3 the upper limit

Transudative:

1) Pleural/serum protein ratio < 0.5
2) Pleural/serum LDH ratio < 0.6
3) Pleural LDH <2/3 the upper limit

Question 8

What is the diagnostic Ix for pleural effusion?

Answer 8

Pleural tap (unless CCF then echo)

Question 9

What things might you send for from a pleural tap?

Answer 9

Cytology, MC+S, Gram stain, immunology i.e ANA, complement, Rheumatoid factor (if indicated)

Protein, glucose, pH, LDH, amylase

Question 10

Treatment for pleural effusion?

Answer 10

Treat the underlying cause

Chest drain