Pleural Effusion Flashcards
what does a pleural effusion sound like on percussion?
stony dullness
how does vocal resonance help diagnosis?
will change in pleural effusion (reduce over the effusion)
what is an exudate pleural effusion?
pleural effusion aspirate with high protein (>30 g/L) meaning the source of effusion is from within the pleura
between 25-35 g/L then apply lights criteria
what is a transudate pleural effusion?
pleural effusion aspiration with low protein (<30 g/L) meaning the source is outwith the pleura (e.g. heart, liver, kidneys)
between 25-35 g/L then apply lights criteria
causes of exudative effusions
- infection
- malignancy
- inflammatory conditions
- pulomary infarct
- trauma
causes of transudative effusions
- congestive cardiac failure
- cirrhosis
- nephrotic syndrome/chronic kidney disease
- GI malabsportion/malnutrition (e.g. coeliac disease)
- hypothyriodism
- meig’s syndrome
what type of pleural effusion is more likely to be bilateral?
transudative
what are the classical symptoms for pleural effusion?
- dyspnoea
- reduced exercise tolerance
- chest pain
what procedure is undertaken to examine the pleural fluid?
ultrasound-guided thoracentesis
what is empyema?
pus in the pleural space
how does empyema present on a chest x-ray?
pleurally based, homogenous opacity that is not gravity dependent
what are the risk factors for empyema?
- trauma
- pneumonia
- immunocompromised states
how do you diagnose empyema?
pleural tap with a pH of <7.2 or a positive gram stain
what is the treatment for empyema?
urgent drainage and IV antibiotics
what criteria do you follow if the pleural effision aspirate has protein levels of 25-35 g/L?
Light’s Criteria
exudative if >=1 of the following criteria are met:
* pleural fluid protein / serum protein >0.5
* pleural fluid / serum >0.6
* pleural fluid LDH >2/3 upper limit of normal serum LDH
what is meigs syndrome?
eponymous syndrome classified by a triad of - ovarain tumour, pleural effusion and ascites
what finding is commonly seen in pleural fluid aspirate with underlying rheumatoid arthritis?
low glucose levels
what condition causes milky appearance of pleural effusion aspirate?
chylothorax
lymphatic fluid in the pleural space
what finding is commonly seen in pleural fluid aspirate with underlying tuberculosis?
low glucose + heavy blood staining
what finding is commonly seen in pleural fluid aspirate with underlying pancreatitis?
raised amylase
what finding is commonly seen in pleural fluid aspirate with underlying oesophageal perforation?
raised amylase
what finding is commonly seen in pleural fluid aspirate with underlying mesothelioma?
heavy blood staining
what finding is commonly seen in pleural fluid aspirate with underlying pulmonary embolism?
heavy blood staining
