Pleural Effusion

Question 1

What is a pleural effusion?

Answer 1

A build up of fluid in the pleural space of the lungs.

Question 2

What are the types of pleural effusion?

Answer 2

Exudate - capillary permeability

Transudate - interstitial fluid

Question 3

What is the protein count of an exudate pleural effusion?

Answer 3

> 35g/L

Question 4

What is the protein count of a transudate pleural effusion?

Answer 4

<35g/L.

Question 5

What are the main causes of exudative pleural effusion?

Answer 5

INFLAMMATION:
pneumonia
lung cancer
tuberculosis
rheumatoid arthritis

Question 6

What are the main causes of transudate pleural effusions?

Answer 6

congestive heart failure
hypoalbuminia
hypothyroidism

Question 7

What are the symptoms of pleural effusion?

Answer 7

SOB
Reduced exercise tolerance
chest pain

Question 8

what are the signs of a pleural effusion?

Answer 8

If large - deviation of mediastinum/trachea
reduced breath sounds
dullness on percussion
reduced chest expansion on affected side

Question 9

what are the investigations done for pleural effusions?

Answer 9

X-ray

Aspiration

Question 10

what are the signs of a pleural effusion on a chest x-ray?

Answer 10

Blunting of costophrenic angle
fluid in lung fissures
meniscus (in large effusions)
tracheal and mediastinal shift

Question 11

What is shown in aspiration?

Answer 11

pH
White cell count
Protein count

Question 12

What is an empyema?

Answer 12

A pus/infection which is found in the pleural space.

Question 13

What are the signs of an empyema?

Answer 13

ACIDIC <7.2
pus
low glucose
High LDH

Question 14

What are the signs of an empyema?

Answer 14

ACIDIC <7.2
pus
low glucose
High LDH

Question 15

what is the typical history of one empyema?

Answer 15

Improving pneumonia but new/ongoing fever.

Question 16

what is the treatment for pleural effusion?

Answer 16

Treat underlying cause
If this fails:
ultrasound guided pleural aspiration

Large pleural effusion/empyema:
intercostal drain

Last resort:
pleurodesis.