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Year One - Respiratory System > Pleural Effusion > Flashcards

Pleural Effusion Flashcards

1
Q

What is a pleural effusion?

A

It is defined as a collection of fluid within the pleural cavity, which is associated with either increased fluid production or decreased fluid absorption

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2
Q

What are the two classifications of pleural effusion?

A

Transudate Pleural Effusion

Exudate Pleural Effusion

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3
Q

What is a transudate pleural effusion?

A

It is defined as a collection of fluid within the pleural cavity, with a relatively low protein count < 25g/L

Fluid protein/serum protein ratio is < 0.5

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4
Q

What is the general cause of transudate pleural effusions?

A

They are related to fluid movement into the pleural space, resulting in disruption of the hydrostatic and oncotic pressures

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5
Q

How can we remember the general cause of transudate pleural effusions?

A

‘Trans’ = movement

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6
Q

What are the five conditions associated with transudate pleural effusions?

A

Congestive Heart Failure

Liver Failure

Hypoalbuminaemia

Hypothyroidism

Meigs’ Syndrome

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7
Q

What is the most commonly associated condition with transudate pleural effusions?

A

Congestive heart failure

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8
Q

What are the three causes of hypoalbuminaemia?

A

Liver disease

Nephrotic syndrome

Malabsorption

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9
Q

What is Meigs’ syndrome?

A

It is defined as a right sided pleural effusion with ovarian malignancy

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10
Q

Are transudate pleural effusions - unilateral or bilateral?

A

Bilateral

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11
Q

What is an exudate pleural effusion?

A

It is defined as a collection of fluid within the pleural cavity, with a relatively high protein count > 35g/L

Fluid protein/serum protein ratio is > 0.5

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12
Q

What is the general cause of exudate pleural effusions?

A

Inflammation, which results in increased pleural and capillary permeability

This means that protein can leak out of the tissue into the pleural space

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13
Q

What are the seven conditions associated with exudate pleural effusions?

A

Lung Infection

Connective Tissue Disease

Malignancy

Pulmonary Embolism

Pancreatitis

Dressler’s Syndrome

Yellow Nail Syndrome

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14
Q

What two lung infections are associated with exudate pleural effusions?

A

Pneumonia

TB

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15
Q

What is the most commonly associated condition with exudate pleural effusions?

A

Pneumonia

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16
Q

What two connective tissue diseases are associated with exudate pleural effusions?

A

Rheumatoid arthritis

Systemic lupus erythematous

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17
Q

What two malignancies are associated with exudate pleural effusions?

A

Lung cancer

Mesothelioma

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18
Q

Are exudate pleural effusions - unilateral or bilateral?

A

Unilateral

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19
Q

What are the seven clinical features of pleural effusions?

A

Dyspnoea

Dry Cough

Pleuritic Chest Pain

Percussion Stony Dullness

Tracheal Deviation

Reduced Breath Sounds

Reduced Chest Expansion

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20
Q

What side does the trachea deviate to in pleural effusions?

A

It deviates away from the effusion

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21
Q

What clinical feature indicates a severe pleural effusion?

A

Trachea deviation

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22
Q

What are the three investigations used to diagnose pleural effusions?

A

Chest X-Ray (CXR)

Ultrasound Scan

Fluid Aspiration

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23
Q

What are the four signs of pleural effusion on a CXR?

A

Costophrenic Angle Blunting

Fluid In Lung Fissures

Meniscus Sign

Tracheal & Mediastinal Deviation

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24
Q

What are the costophrenic angles?

A

They are the places where the diaphragm meets the ribs

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25
Q

How do costophrenic angles usually appear on CXR?

A

A sharply-pointed, downward indentation between each hemi-diaphragm

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26
Q

What is a lung fissure?

A

A double fold of visceral pleura that either completely or incompletely invaginate lung parenchyma to form the lung lobes

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27
Q

What is the meniscus sign?

A

It is as an upward curving concave line that obscures the costophrenic angle and part/all of the hemidiaphgram

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28
Q

What two CXR signs indicate a severe pleural effusion?

A

Meniscus sign

Trachea deviation

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29
Q

What are the three signs of pleural effusion on US?

A

Pleural Cavity Granulation

Pleural Cavity Loculations

Unclear Pleural Cavity Border

30
Q

How does the pleural cavity usually appear on US?

A

Black

31
Q

How do pleural cavity granulations appear on US?

A

The pleural cavity is grey/white instead of black

32
Q

What are pleural cavity loculations?

A

It is defined as the presence of fibrotic scar tissue in the pleural cavity

33
Q

What is fluid aspiration?

A

It involves collecting a sample of pleural fluid via the insertion of a needle

It is usually conducted under ultrasound guidance

34
Q

Which two pieces of equipment are used to conduct fluid aspiration in pleural effusion?

A

Green 21G needle

50ml syringe

35
Q

What information does fluid aspirate inspection give us about the pleural effusion?

A

The underlying cause

36
Q

What does straw coloured pleural fluid aspirate indicate?

A

No pleural effusion

37
Q

What cause of pleural effusion is indicated with cloudly coloured aspirate?

A

Infection

38
Q

What three causes of pleural effusion are indicated with blood stained aspirate?

A

Malignancy

Pulmonary Embolism

Trauma

39
Q

What cause of pleural effusion is indicated with pus stained aspirate?

A

Empyema

40
Q

What information does fluid aspirate biochemistry give us about the pleural effusion?

A

It enables us to distinguish between the pleural effusion classifications

41
Q

What protein level indicates transudate pleural effusions?

A

< 25g/L

42
Q

What LDH level indicates transudate pleural effusions?

A

Normal levels

43
Q

What protein level indicates exudate pleural effusions?

A

> 35g/L

44
Q

What LDH level indicates exudate pleural effusions?

A

Increased levels

45
Q

What is Light’s criteria?

A

It is defined as a list of criteria to determine exudate pleural effusion diagnosis

It states that if one or more of the following criteria are met then the fluid is an exudate

46
Q

What are the three Light’s criteria?

A

Fluid Protein/Serum Protein > 0.5

Fluid LDH/Serum LDH > 0.6

Fluid LDH 2/3 Upper Limit of Normal Serum LDH

47
Q

In which pleural effusions patients do we recommend no treatment in?

A

In individuals who have smaller pleural effusions, with the absence of clinical features

48
Q

What are the two pharmacological management options for pleural effusion? When do we administer them?

A

Diuretics (Heart Failure)

Antibiotics (Infection)

49
Q

How is fluid aspiration used to manage pleural effusions?

A

It can temporarily relieve the pressure in the pleural space

50
Q

What is the disadvantage of fluid aspiration to manage pleural effusion?

A

The effusion may reoccur, and repeated aspiration may be required

51
Q

What is a chest drain?

A

It involves collecting a sample of pleural fluid via the insertion of a drain

It is usually conducted under ultrasound guidance

52
Q

How much fluid do we remove from a chest drain to treat pleural effusions? Why?

A

One and a half litres

If more fluid is removed, hypotension and pulmonary oedema can occur

53
Q

Where are chest drains inserted?

A

‘Triangle of safety’

54
Q

What are the three borders that form the triangle of safety?

A

5th Intercostal Space

Mid-Axillary Line

Anterior Axillary Line

55
Q

What anatomical landmark is used to locate the 5th intercostal space?

A

Inferior nipple border

56
Q

Which border of the ‘triangle of safety’ does the 5th intercostal space form?

A

Inferior

57
Q

What anatomical landmark is used to locate the mid-axillary line?

A

Lateral edge of the latissimus dorsi

58
Q

What anatomical landmark is used to locate the anterior axillary line?

A

Lateral edge of the pectoris major

59
Q

Which border of the ‘triangle of safety’ does the mid-axillary line form?

A

Lateral border

60
Q

Which border of the ‘triangle of safety’ does the anterior axillary line form?

A

Anterior border

61
Q

What investigation should be conduced after insertion of a chest drain? Why?

A

CXR

To confirm correct positioning

62
Q

Do we insert the chest drain needle above or below the rib? Why?

A

Above the rib

To avoid the neurovascular bundle that runs just below the rib, containing the long thoracic nerve

63
Q

What occurs when there is damage to the long thoracic nerve?

A

Winging of the scapula

64
Q

What is pleurodesis?

A

It involves insertion of a mildly irritant drug into the pleural space, in the aim to cause inflammation of the visceral and parietal pleura

This will cause bonding of these two surfaces, in the aim to seal the pleural space between them and prevent further collection of fluid

65
Q

In what two ways can we conduct pleurodesis?

A

Chest drain

Medical thoracoscopy

66
Q

What surgery is used to treat pleural effusion?

A

Video-Assisted Thoracic Surgery (VATS)

67
Q

What is VATS?

A

It is defined as a minimally invasive surgical technique used to diagnose and treat respiratory problems

68
Q

How can VATS be used to treat pleural effusions?

A

This surgery can be used to seal the pleural space

69
Q

What is empyema a classification of?

A

Parapneumonic effusion

70
Q

What is empyema?

A

It is defined as pleural effusion development in relation to pneumonia infection

This results in a collection of pus within the pleural cavity

71
Q

What are the five features that distinguish empyema from other pleural effusions?

A

Improving Pneumonia, New/Ongoing Fever

Pus In Pleural Fluid Aspirate

Pleural Fluid Aspirate < 7.2

Reduced Glucose Levels

Increased LDH Levels

72
Q

What are the two management options for empyema?

A

Chest Drain

IV Antibiotics

Year One - Respiratory System (14 decks)

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