MRCP Resp > pleural effusion > Flashcards
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Pleural effusion: causes translate
< 30g/L protein)
heart failure (most common transudate cause)
hypoalbuminaemia
liver disease
nephrotic syndrome
malabsorption
hypothyroidism
hypothyroidism
Meigs’ syndrome
cause ofan exudate Exudate (> 30g/L protein)
infection :
pneumonia (most common exudate cause),
tuberculosis
subphrenic abscess
connective tissue disease :
rheumatoid arthritis
systemic lupus erythmatosus
neoplasia :
lung cancer
mesothelioma
metastases
pancreatitis
pulmonary embolism
Dressler’s syndrome
yellow nail syndrome
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diagnosis of Pleural effusion ?
posterioranterior (PA) chest x-rays
ultrasound is recommended - increase likelihood of pleural aspirations
sensitive for detecting pleural fluid septations
what is taken to investigate the underlying cause of pleural effusion
contrast CT
pleural fluid aspiration from USG needles should be sent for what ?
pH,
protein,
lactate dehydrogenase (LDH), cytology
and microbiology
what criteria was developed in 1972 to help distinguish between a transudate and an exudate ?
Light’s criteria
FOR BORDERLINE CASES
what are the borderline cases ?
exudate protein level of >30 g/L,
transudates have a protein level of <30 g/L
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
pleural fluid findings of
low glucose
rheumatoid arthritis, tuberculosis
pleural fluid findings of
raised amylase
pancreatitis,
oesophageal perforation
pleural fluid findings of
heavy blood staining
mesothelioma,
pulmonary embolism,
tuberculosis
who requires diagnostic pleural fluid sampling
patients with a pleural effusion in association with sepsis or a pneumonic illness
what determines if a chest tube should be placed due to findings in the pleural fluid ?
fluid is purulent or turbid/cloudy
fluid is clear but the pH is less than 7.2 in patients with suspected pleural infection a chest tube should be placed
Options for managing patients with recurrent pleural effusions include:
recurrent aspiration
pleurodesis
indwelling pleural catheter
drug management to alleviate symptoms e.g. opioids to relieve dyspnoea
