Pleural effusion Flashcards
What is a pleural effusion
collection of fluid in the pleural space
What is transudate ?
Pleural fluid protein < ½ serum
protein
Less than 3G protein
What occurs in transudate pleural effusion
Increased hydrostatic pressure or reduced osmotic pressure - causes fluid to move from the capillaries into the pleural sac.
What can cause transudate PE
- HF
- Cirrhotic liver disease
- renal failure
- hypoalbuminemia
- ascites
What is exudate
Pleural fluid protein > ½ serum protein
What occurs in exudative PE
Increased capillary permeability and impaired reabsorption
caused by inflammation, infection and malignancy. The inflammation results in protein e.g. LDH leaking out of the tissues and into the pleural space
What can cause exudative PE
- Pneumonia
- Cancer
- TB
- Autoimmune conditions e.g. RA, SLE
- PE
- Benign Asbestos related pleural effusion
- Pancreatitis
signs of PE
- reduced chest wall expansion
- quiet breath sounds
- stony dull percussion
- meditational shift away from affected side
Symptoms of PE
- Shortness of breath
- Cough
- Pleuritic chest pain
- Symptoms of the underlying caus
First line investigation for PE
CXR- reveal blunting of the costophrenic angle or white out of one hemifield (if large
What would bloods show for PE
FBC- infection
U&E - raised creatitine suggestive of renal impairment ]
Diagnostic ultrasound-guided thoracentesis is required in all patients except…?
- Those with clear evidence of heart failure
- raised jugular venous pressure
- pitting ankle oedema
When can lights criteria be applied
- If the protein content is equivocal to 25-35g/l
Management of PE
- TREAT UNDERLYING CAUSE
- diuretics for HF
- dialysis for renal failure
-ABCDE - Oxygen therapy
- intercostal drain : for large pleural effusions
- for recurrent PE pleurodesis should be considered
If these are present in fluid analysis chest tube drainage is required
- Purulent or turbid/cloudy pleural fluid
- Positive pleural fluid Gram stain or culture
- Pleural fluid pH <7.2
- Loculated pleural collection
Non - malignant treatment
- Treat the underlying cause
- Thoracentesis for symptomatic effusion
Treatment of recurrent effusions
- Pleurodesis:scarring the pleural space by slurry injection or spraying sterile talc, this causes adhesion of the visceral and parietal pleura and prevents recurrence
- Recurrent aspiration
- Indwelling pleural catheter:a chest tube tunnelled under the skin used for long-term repeated pleural drainage
Criteria that would support a pleural infection
- pH < 7.2
- Glucose < 3.4mmol/L
- PF LDH > 1000 IU/L
- Bacterial growth on culture
- Macroscopic appearance of pus
What is an empyema
pus in pleural space
Causes of empyema
Community acquired
- S milleri/ S pneumo / S aureus
Hospital acquired
- MRSA/ S. Aureus / Enterococci
Symptoms of empyema
- patient unwell/ not improving
- swinging fevers
- cough
Tx for empyema
- Ab
- chest drain
- surgery
What is a haemothorax
Blood in pleural cavity
Haematocrit > 50%
Causes of haemothorax
- trauma
- Post operative
- bleeding disorders
- lung cancer
management of Haemothorax
- large bore chest drain
- possible vascular intervention
- surgical opinion
What is a hydropneumothorax
- air and fluid in pleural space
What is pleural thickening
- thickening of visceral / parietal pleura
- related to asbestos
- follows infection
What is Pneumomediastinum
air in mediastinum
Treatment of recurrent effusions
- Pleurodesis:scarring the pleural space by slurry injection or spraying sterile talc, this causes adhesion of the visceral and parietal pleura and prevents recurrence
- Recurrent aspiration
- Indwelling pleural catheter:a chest tube tunnelled under the skin used for long-term repeated pleural drainage
