Pleural Effusion Flashcards
What is pleural effusion
Abnormal build up of fluid in the pleural cavity
What are the 2 categories of causes of pleural effusion
Exudative and transudative
Depends on protein content of the pleuritic tap
What is the protein content for exudative pleural effusions
Protein content above 35 g/L
What is the protein content for transudative pleural effusion
Protein content less than 35 g/L
Causes of exudative pleural effusion
Anything that causes increased capillary permeability:
Infections such as TB or pneumonia
Malignancy
Inflammatory conditions such as rheumatoid arthritis, pancreatitis and lupus
Pulmonary infarcts due to PE or trauma
Causes of transudative pleural effusion
Imbalances in the starling forces that form interstitial fluid.
Congestive cardiac failure (condition that increases capillary hydrostatic pressure)
Liver cirrhosis, nephrotic syndrome/ CKD, GI malabsorption (conditions that decrease oncotic pressure)
What is meigs syndrome and what type of pleural effusion is it a cause of (less common)
It is the triad of ascites, transudative pleural effusion and benign ovarian tumour)
Symptoms of pleural effusion
Shortness of breath
Reduced exercise tolerance
Pleuritic chest pain
Signs of pleural effusion
Tachypnoea,
Tracheal deviation contralateral Reduced chest expansion ipsilaterally Percussion note dull ipsilaterally Reduced breath sounds on affected region Fremitus reduced over affected region
Signs of infective causes
Fever
Signs of malignant causes
Cachexia and clubbing
Signs of heart failure causing pleural effusion
Ankle oedema, raised JVP
Investigations for pleural effusions
Bloods ; Fbc, U&Es, LFTs
Imaging; CXR will show blunting of costophrenic angle and white out of affected region
LFTs if the pleural effusion is due to hepatic cirrhosis
Low albumin, raised AST/ ALT
Management of pleural effusion
AXE assessment, administer oxygen, use diuretics
Chest drain
