Pleural Effusion Flashcards
What is pleural effusion?
Collection of fluid in the pleural cavity
What are the two types of pleural effusion?
Exudative
Transudative
What does it mean for pleural effusion to be exudative?
A high protein count (>3g/dL)
Related to inflammation
What does it mean for pleural effusion to be transudative?
A lower protein count (<3g/dL)
Fluid moving across into the pleural space (trans- meaning moving across). Think of the causes of fluid shifting
What are exudative causes?
Lung cancer
Pneumonia
Rheumatoid arthritis
Tuberculosis
What are transudative causes?
Congestive cardiac failure
Hypoalbuminaemia
Hypothroidism
Meig’s syndrome (right sided pleural effusion with ovarian malignancy)
Presentation
Shortness of breath
Dullness to percussion over the effusion
Reduced breath sounds
Tracheal deviation away from the effusion if it is massive
What will a CXR show
Blunting of the costophrenic angle
Fluid in the lung fissures
Larger effusions will have a meniscus.
This is a curving upwards where it meets the chest wall and mediastinum.
Tracheal and mediastinal deviation if it is a massive effusion
What is the treatment of pleural effusion?
Pleural aspiration - sticking a needle in and aspirating the fluid
Thoracocentesis
Chest drain - drain effusion and prevent it recurring
When it Light’s criteria used in the diagnosis of pleural effusion?
If pleural fluid protein is 25-35g/L, Light’s criteria are used to distinguish transudative from exudative pleural effusions.
What does Light’s criteria state?
The fluid is an exudate if one or more of the following criteria are met:
Pleural fluid protein divided by serum protein is >0.5
Pleural fluid LDH divided by serum LDH is >0.6
Pleural fluid LDH is >⅔ the upper limit of the laboratory normal value for serum LDH
What would be seen in clinical examination?
Peripheral
Nicotine staining of fingers
Clubbing (lung cancer)
Evidence of joint deformity (rheumatoid arthritis)
Signs of fluid overload (heart failure)
What would be seen in clinical examination?
Closer inspection of chest
Reduced chest movement on the affected side
What would be seen in clinical examination?
Palpation
Tracheal deviation away from affected side
Reduced chest expansion on affected side
What would be seen in clinical examination?
Percussion and auscultation
Sounds ‘stony’ dull.
When auscultating, breath sounds and vocal resonance are reduced or absent over an effusion.
