Pleural Effusion Flashcards
Pleural fluid characteristics that suggests need for chest tube drainage?
- Empyema (pus in plural space)
- Positive Gram stain
- Loculation
- PH 1000
Light criteria?
For fluid to be labeled exudate must meet one of these criteria:
- Pleural Protein/serum protein >.5
- Pleural LDH/serum LDH >.6
- Pleural LDH >2/3 normal serum LDH
Amount of fluid needed in order to be visible on the lateral decubitus film? Amount of fluid needed to obscure entire hemidiaphragm on x-ray?
50 mL; 500 mL
Clear yellow pleural fluid suggests?
Frank pus?
Milky/turbid?
Dark green?
Transudate process
Infectious process/empyema
Chylothorax triglycerides >110 resulting from disruption thoracic duct or Cholesterol effusions
Biliothorax
Bloody pleural fluid strata?
50% hemothorax secondary to trauma, malignancy, PE
How much fluid can be safely removed in a therapeutic thoracentesis? Risk if more than this amount is removed?
1500 mL; reexpansion pulmonary edema
Causes of transudative pleural effusions and radiographic features?
- CHF – bilateral/symmetric or right-sided effusion
- Nephrotic syndrome – bilateral and subpulmonic effusions
- Cirrhosis – patients also have ascites
- Malignancy – obstructed lymphatics
- PE
- Hypothyroidism
Signs of pleural effusion due to tuberculosis?
Lymphocytes >80%
Adenosine deaminase >43
Protein > 4
< 10% acid-fast bacilli
If chest tube is initially placed it is kept until?
Drainage rate has decreased to < 50 mL per day
Treatment of multiloculated empyema?
Fibrinolytic agents (streptokinase or urokinase) through the chest tube
Exudative pleural effusions: signs of connective tissue disease?
Low glucose
LDH >1000
Pleural effusion with Amylase suggests?
Pancreatitis or esophageal rupture
Indications for thoracentesis?
- Uneven/unilateral pleural effusion
- Evidence of infection (productive cough, fever)
- Normal cardiac silhouette
- Alarming signs: weight loss, hemoptysis, hypoxia
