Pleural Effusion Flashcards
How do you classify pleural effusion?
transudate or exudate according to the protein concentration
What is Transudate pleural effusion?
< 30g/L protein
What is the most common transudate pleural effusion cause?
heart failure
What are the causes of transudate pleural effusion?
heart failure (most common transudate cause)
hypoalbuminaemia (liver disease, nephrotic syndrome, malabsorption)
hypothyroidism
Meigs’ syndrome
What is exudate pleural effusion?
> 30g/L protein
What is the most common exudate pleural effusion cause?
pneumonia
What are the causes of exudate pleural effusion?
infection: pneumonia (most common exudate cause), TB, subphrenic abscess
connective tissue disease: RA, SLE
neoplasia: lung cancer, mesothelioma, metastases
pancreatitis
pulmonary embolism
Dressler’s syndrome
yellow nail syndrome
What are the features of pleural effusion?
dyspnoea, non-productive cough or chest pain are possible presenting symptoms
classic examination findings include dullness to percussion, reduced breath sounds and reduced chest expansion
AP CXR should be performed in all patients with suspected pleural effusiion
false!
posterioranterior (PA) chest x-rays should be performed in all patients
What investigation increases the likelihood of successful pleural aspiration?
US is reccomended
sensitive for detecting pleural fluid septations
Which investigation is useful for investigate the underlying cause?
CT contrast
particularly for exudative effusions
What needle is used for pleural aspiration?
a 21G needle and 50ml syringe
What should fluid from pleural aspirate be sent for?
pH, protein, lactate dehydrogenase (LDH), cytology and microbiology
In pleural fluid low glucose is a common finding in?
rheumatoid arthritis, tuberculosis
In pleural fluid raised amylase is a common finding in?
pancreatitis, oesophageal perforation
In pleural fluid heavy blood staining is a common finding in?
mesothelioma, pulmonary embolism, tuberculosis
All patients with a pleural effusion in association with sepsis or a pneumonic illness require what?
diagnostic pleural fluid sampling
When should you be place a chest tube for drainage?
if the fluid is purulent or turbid/cloudy
if the fluid is clear but the pH is less than 7.2 in patients with suspected pleural infection
What are the options for managing recurrent pleural effusion?
recurrent aspiration
pleurodesis
indwelling pleural catheter
drug management to alleviate symptoms e.g. opioids to relieve dyspnoea
Which criteria is used for borderline cases?
Light’s criteria
if the protein level is between 25-35 g/L, Light’s criteria should be applied
An exudate is likely if at least one of the following criteria are met:
pleural fluid protein divided by serum protein >0.5
pleural fluid LDH divided by serum LDH >0.6
pleural fluid LDH more than two-thirds the upper limits of normal serum LDH
