Pleural Effusion

Question 1

what is pleural effusion

Answer 1

excess build up of fluid in pleural cavity

Question 2

what does it mean if a pleural effusion is exudative

Answer 2

there is ^ protein count (>3g/dL)

Question 3

what does it mean if a pleural effusion is transudative

Answer 3

there is relatively lower protein count (<3g/dL)

Question 4

what are exudative causes of pleural effusion related to

Answer 4

inflammation

Question 5

how does inflammation in exudative pleural effusion result

Answer 5

protein leaks out of tissues in to the pleural space

Question 6

give some examples of causes of inflammation in pleural effusion

Answer 6

• lung cancer
• pneumonia
• rheumatoid arthritis
• tuberculosis

Question 7

what are transudative causes of pleural effusion related to

Answer 7

fluid moving across into the pleural space

Question 8

give some examples of of causes of fluid shifting in transudative pleural effusion

Answer 8

• congestive cardiac failure
• hypoalbunaemia
• hypothyroidism
• Meig’s syndrome

Question 9

describe the presentation of pleural effusion

Answer 9

• SoB
• dullness to percussion over the effusion
• reduced breath sounds
• tracheal deviation and mediastinal shift away from effusion if it is massive

Question 10

what investigations can be done in suspected pleural effusion

Answer 10

• chest xray
• taking a sample of pleural fluid by aspiration or chest drain
• -> analyse it for protein count, cell count, pH, glucose, LDH, and microbiology testing

Question 11

what might be seen in a CXR of a pleural effusion

Answer 11

• blunting of costophrenic angle
• fluid in lung fissures
• larger effusions have a meniscus
• tracheal and mediastinal deviation if it is a massive effusion

Question 12

outline the treatment for pleural effusion

Answer 12

• conservative management
• -> small effusions will resolve w/ treatment of underlying cause
• pleural aspiration
• -> sticking in needle and aspirating fluid
• -> can temporarily relieve pressure but effusion may recur and repeated aspiration may be required
• chest drain
• -> drain effusion and prevent it recurring

Question 13

what is empyema

Answer 13

infected pleural effusion

Question 14

when might you suspect empyema

Answer 14

• in a Px w/ improving pneumonia but new or ongoing fever
• pleural aspiration shows pus
• low glucose
• acidic (pH <7.2)
• ^ LDH

Question 15

what is the treatment of empyema

Answer 15

• chest drain to remove pus

- antibiotics