Pleural Effusion Flashcards
How do we seperate exudate and transudate pleural effusions?
An Exudate contains >30g/L of protein
A Transudate contains <30g/L of protein
What is an exudate pleural effusion?
Fluid leaking out capillaries with an increased permeability, often due to inflammation
What is a transudate pleural effusion?
Fluid forced out capillaries due to high venous pressure.
What are the common symptoms/signs of pleural effusion?
Symptoms - Chest pain, Dyspnoea
Signs - Reduced chest expansion & vocal resonance, stony dullness to percussion and increased jugular venous pressure (JVP).
What are the common causes for a transudate effusion?
Left Ventricular Failure
Liver Cirrhosis (leads to low albumin)
Hypoalbuminaemia
Peritoneal Dialysis
What are the common causes of an exudate effusion?
Malignancy Pneumonia or Abscess Pulmonary Embolism Autoimmune Pancreatitis
What investigation is done to confirm a pleural effusion?
A CXR
What investigation is done to determine the type/cause of the effusion/
An aspiration. 50ml is removed with a 21G needle and tested.
Waht are the complications of aspirating a pleural effusion?
haemothorax
Air embolism
Pulmonary Oedema
Pneumothorax, empyema
What can you tell just from looking at a sample of aspirated pleural effusion?
Foul smell - Anaeorbic empyema
Food - Oesophageal Rupture
Milky - Chylothorax
Blood Stained - Malignancy, haemothorax, trauma
What can we test an aspiration sample for in the lab?
Increased amylase - Pancreatitis
Protein level - exudate/transudate
Bacterial cultures
Malignant cells, lymphocytes and eosinophils
How do we distinguish between exudate & transudate when its very close to the tipping point?
If an of Light’s criteria are met its an exudate:
pleural/serum protein > 0.5
Pleural/Serum LDH > 0.6
Pleural/Serum(upper limit) LDH > 0.66
What tests can be done for a pleural effusion?
- CXR
- CT
- Pleural Aspiration
- Pleural Biopsy
What kind of pleural effusion is unilateral vs bilateral?
Exudates are often unilateral
Transufates are oftem bilateral
How do we treat a pleural effusion?
The fluid must be drained. Patient’s bed at 45 degrees with arm above head. drain in 4 Intercostal space in mid-axillary line.
Pleurodhesis can be performed if repeat offender. (talc poudrage)