Pleural effusion Flashcards
What is a pleural effusion?
Build up of fluid in the pleural cavity
What are the main presentations of pleural effusion?
- Dyspnoea
- Non-productive cough
- Chest pain
What would you find on examination of someone with a pleural effusion?
- Reduced breath sounds
- Reduced chest expansion
- Dullness to percuss over effusion
What sign might you find with a large pleural effusion?
Tracheal deviation
What is the protein content of an exudative pleural effusion?
More than 30g/L (3g/dL) of protein
What is the protein content of an transudative pleural effusion?
Less than 30g/L (3g/dL) of protein
What criteria is used to differentiate between transudative and exudative pleural effusions in borderline cases?
Lights criteria
When would lights criteria be applied?
If the protein level is between 25-35 g/L, Light’s criteria should be applied.
What is the main exudative cause of a pleural effusion?
Pneumonia
What are the other possible exudative causes of pleural effusion?
- Infection: Tuberculosis/ pneumonia
- Connective tissue: Rheumatoid arthritis/ SLE
- Malignancy: Lung cancer
What is the main transudative cause of a pleural effusion?
Heart failure
( or Constrictive pericarditis)
What are the other possible transudative causes of pleural effusion?
- Hypoalbuminaemia
- Hypothyroidism
- Meigs’ syndrome’s
What does hypoalbuminaemia/ hypoproteinaemia include?
Liver disease (cirrhosis)
Nephrotic syndrome
Malabsorption
What is Meig’s syndrome?
Triad of:
Pleural effusion
Benign ovarian tumour
Ascites
What is the main investigation for pleural effusion?
Chest x-ray (Posterior-anterior (PA) )
What might you see on a chest x-ray that would indicate pleural effusion?
- Blunting of the costophrenic angle
*White out of one hemifield (if large)
*Fluid in lung fissures
What is the function of an ultrasound?
Increases the likelihood of successful pleural aspiration
What can a contrast CT be used for in someone with a pleural effusion?
Investigating the underlying cause
What would low glucose and high protein in the fluid indicate?
Rheumatoid arthritis
Tuberculosis
What would heavy blood staining and high protein in the fluid indicate?
Tuberculosis
What would a fluid with a pH <7.2 indicate?
Empyema
What is the most important factor in determining if a chest tube is placed or not?
pH
What is the initial management of a pleural effusion?
Oxygen therapy and attempts to reduce respiratory distress medically
What would you do after attempts to reduced respiratory distress fail?
Ultrasound guided pleural aspiration
What is the management of a pleural effusion if there are increasing oxygen requirements?
Chest drain
What is the management for large pleural effusions or empyema’s?
Intercostal drain
What can be considered for recurrent pleural effusions?
Pleurodesis or pleurectomy
What would you see on a chest x-ray of a small pleural effusion?
Blunting of the costophrenic angle
What is the function of USS in someone with a pleural effusion?
Identifying the presence of pleural fluid
Guiding diagnostic or therapeutic aspiration
When would you consider carrying out a CT scan in someone with pleural effusion?
If it is exudative effusion, CT should be done to asess pleural thickening and nodularity, and look for underlying cause
What would you look for in a CT scan of someone with an exudative pleural effusion?
Pleural thickening and nodularity
Look for underlying cause
When would you carry out a CT scan in someoen with an exudative pleural effusion?
After it has been drained
