Pleural Effusion Flashcards
Pleural effusion definition
Presence of any type of fluid in pleural space ( transudate, exudate, frank pus, blood, chyle)
Name and cause of disease with transudate in pleural space
Hydrothorax
In HF
Name and cause of disease with exudate in pleural space
Sera pus
Pneumonia
Name of disease with frank pus in pleural space
Empyema thoracis
Name of disease with blood in pleural space
Hemothorax
Name of disease with chyle in pleural space
Chylothorax
Broad causes of pleural effusion
Pleural membrane disease
Intrathoracic organs disease
Sub-diaphragmatic/ abdominal disease
Systemic disease
Different effets of pleural effusion
Collapse of lungs at varying degree
Mediastinal shift
Diagrammatic depression
Occasional cyanosis
Significant dyspnea
Cardiorespiratory embarrassment
Main causes of purulent and seropurulent pleural effusion
Tuberculosis (not in seropurulent )
Mycosis
Amoebiasis
Pulmonary infarction
Ovarian fibroma
Collagen disease
Pericarditis
Pancreatitis
Post pneumonic ( not in purulent )
Main causes of empyema
Post pneumonic
Lung abscess
Subphrenic abscess
Main causes of chylothorax
Trauma
Parasitic
Lymphatic
Main cause of hemothorax
Trauma
Symptoms suggesting Parapneumonic effusion
Short history of cough, fever, pleuritic chest pain
Symptoms that suggest TB
Long history of cough, weight loss, drenching night sweats , fever
If arthritis in a patients, disease you should think about
SLE
Rheumatoid arthritis
If history of surgery for malignancy , yo should think about this when there is chest presentation
Carcinomatous involvement of the pleura
Disease of interest when doing physical examination
Congestive cardiac failure
Meigs syndrome
Collagen dx
Stigmata of SLE or RA
Amoebic liver abscess
Tuberculosis
Severe weight loss
Goals of imaging in pleural effusion
Degree of pleural effusion
Underlying dx identification
Pleural thickening , plaques in mesothelioma
Do you see fluid accumulation posteriorly or frontally first in xray
Posteriorly and then in the front
Earliest sign of pleural effusion in frontal view in xray
Blunting of costophrenic angles
Amount of fluid required to see blunting on frontal view in xray
175ml
Sign of large free pleural effusion except in hydropneumothorax in xray
Meniscus shaped contour convex meniscus
Silhouette sign
Signs of very large pleural effusion in xray
Opaque hemithorax with mediastinal shift to contralateral side
What do you see on chest xray of pleural effusion due to malignancy
Canon balls and masses
Advantage of ultrasound
Can see fluid as small as 3-5ml and Loculation
Can guide thoracocentesis in small fluid collection
Sign of exudative effusion in ultrasound
Plankton sign with punctate, hyperechoic foci floating in effusion
Ct scan Advatanges
Helps confirm diagnosis of effusion
Skin tests done in pleural effusion
Tuberculin/PPD in tuberculosis
Cocciodiocin skin test for coccidiodomycosis
Sputum studies done in pleural effusion
ZN stain in AFB for TB
Microscopy for infection
Cytology for malignancy
Culture and sensitivity for infection
Features noted on thoracocentesis
Appearance
Thickness
Amount over specified time
Biochem (glucose, protein, fat, enzymes )
Cytology
Transudate definition
Fluid formed by increase in hydrostatic pressure or decreased capillary oncotic pressure
Disease leading to transudate accumulation
Cardiac failure
Nephrotic syndrome
cirrhosis of liber
Dressler’s syndrome
Trauma
Asbestos
Yellow nail syndrome
Urinothorax
Medications (dasatinib)
Exudate definition
increase in permeability of micro circulation or alteration in pleural space drainage to lymph nodes
Dx leading to exudate accumulation
Bronchial carcinoma
Secondary Malignancy
Pneumonia
Tb
Mesothelioma
RA
SLE
Lymphoma
Disease causing straw colored pleural fluid
Autoimmune
Parapneumonic
Malignant
Disease causing Chocolate brown pleural fluid
Amoebic pleural effusion
Disease causing milky and turbid pleural fluid
Chylothorax
Disease causing hemorrhagic /bloody pleural fluid
Trauma
TB
Malignancy
Rheumatoid arthritis biochemistry
glucose in pleural fluid less than 30mg%
TB biochemistry
Fluid glucose > blood glucose
Malignant dx biochemistry
Fluid glucose < blood glucose
Cytology with malignant cells in effusion in 50% of cases
CCF , SLE, infection biochemistry
Fluid glucose = blood glucose
Chylothorax biochemistry
Pleural fluid fat above 400mg
Acute pancreatitis biochemistry
Raised serum amylase
Treatment pleural effusion
Drainage
Treatment of underlying dx
4 ways to drain pleural effusion
Needle aspiration
catheter aspiration
Closed tube thoracostomy
Pleuropneumonectomy
