Pleural Effusion Flashcards
Difference in exudative and trasudative?
Exudative more than 3g/dl, transudative less than 3g/dl
Exudative causes?
Lung cancer, TB, rheumatoid arthritis, Pneumonia, pancreatitis, dresslers syndrome (pericarditis), yellow nail syndrome PE
Transudative causes?
Hypoalbuminaemia
Meigs syndrome- right sided pleural effusion, ovarian cancer, ascites
Congestive cardiac failure
Hypothyroidism
Presentation of Pleural Effusion?
Sob, non productive cough, chest pain, dullness to percussion, reduced breath sounds, tracheal deviation away from effusion, reduced chest expansion
CXR for pleural effusion will show?
Blunting of costrophrenic angle, fluid in fissures, meniscus, tracheal and mediastinal deviation
What should you check for in pleural effusion?
LDH, glucose, protein count, cell count, pH, microbiology testing
If large effusion what should be done?
Pleural aspiration (needle) effusion may recur
Chest drain
What is empyema?
Infected pleural effusion. Suspect in patients who have improving pneumonia but new or ongoing fever.
What will empyema show?
Pus, acidic pH<7.2, low glucose high LDH
How to treat empyema?
Chest drain and antibiotics
What do you need for successful pleural aspiration?
US- also helps identify pleural fluid septations
Lights criteria?
If protein level between 25-35g/l, an exudate is more likely if pleural fluid protein/serum protein>0.5,
Pleural fluid LDH/serum LDH>0.6 and pleural fluid LDH is more than 2/3 the upper limits of normal serum LDH
If pleural fluid has low glucose suggestive of?
Rheumatoid arthritis and tuberculosis
If raised amylase in pleural fluid then?
Pancreatitis or oesophageal perforation
If heavy blood staining in pleural fluid then?
Mesothelioma, PE, TB
