Pleural Effusion

Question 1

Pleural effusion diagnostics

Answer 1

CT, CXR, ultrasound
May need thoracentesis with chest tube and analysis

Question 2

Transudative causes of pleural effusion

Answer 2

CHF, Cirrhosis, Nephrotic syndrome, peritoneal dialysis, SVC obstruction, myxedema, urinothorax

Question 3

Exudative causes of pleural effusions

Answer 3

Neoplastic diseases, infectious diseases, pulmonary embolism or infarction, trauma

Question 4

What indicated exudative fluid on a pleural fluid analysis

Answer 4

Protein/serum protein <0.5
LDH/ Serum LDH >0.6
LDH>2/3 normal upper serum limit

Question 5

What indicates Transudative pleural fluid on analysis

Answer 5

Serum protein/pleural fluid protein gradient >3.1

Question 6

What does a low glucose <60 on exudative pleural fluid indicate

Answer 6

Malignancy vs bacterial infection vs rheumatoid pleuritis

Question 7

If pleural fluid analysis comes back negative consider what cause?

Answer 7

PE

Question 8

If pleural a fluid analysis is negative and PE is negative consider what cause?

Answer 8

TB

Question 9

If pleural fluid analysis and PE and TB work up is negative what is the next step?

Answer 9

Thorascopy or pleural biopsy

Question 10

Absolute pleural fluid findings that indicate a need for complete drainage

Answer 10

pH<7.2, gluocse <60, LDH>1000, bacteria present

Question 11

What is the most common cause of pleural effusions

Answer 11

Heart failure

Question 12

What is the presentation for pleural effusions d/t HF

Answer 12

Not bilateral, febrile, pleuritic chest pain
Pleural fluid ProBNP >1500

Question 13

Treatment plan for pleural effusions due to heart failure

Answer 13

Treat underlying HF with possible thoracentesis

Question 14

What is the predominant mechanism for pleural effusions caused by hepartic hydrothroax

Answer 14

Direct movement of peritoneal fluid into the plural space causing a right sided effusion

Question 15

What is the most common exudative pleural effusion cause

Answer 15

Parapneumonic

Question 16

What are the underlying causes of parapneumonic pleural effusions

Answer 16

Bacterial pneumonia, lung abscess, or bronchiectasis

Question 17

S/S of aerobic vs anaerobic vs empyema of parapneumonic pleural effusions

Answer 17

Aerobic: acute febrile, chest pain, sputum production, leukocytosis
Anaerobic: subacute illness, weight loss, mild anemia, aspiration
Empyema: grossly purulent effusion

Question 18

Treatment of pleural effusions caused by parapneumonic including recurrent infections

Answer 18

Effusion >10mm: thoracentesis
-pH <7.2, Glucose <60, gram stain +: invasive approach
If reoccurrence may need chest tube with TPA
Thoracoscopy
Decorticating

Question 19

Second most common cause of exudative effusions

Answer 19

Malignancy of lung, breast, or lymph

Question 20

S/s of pleural effusion caused by malignancy

Answer 20

Dyspnea out of proportion, ctyology

Question 21

Pleural effusion caused by malignancy treatment

Answer 21

Symptomatic relief
Thoracostomy tube
Sclerosing agent like doxycycline

Question 22

What is the etiology of pleural effusions caused by chylothroax

Answer 22

Disruption of the thorasic duct accumulating chyle

Question 23

Most common causes of chylothorax pleural effusions

Answer 23

Trauma from thoracic surgery, mediastinal tumors

Question 24

S/s of chylothorax pleural effusions

Answer 24

Dyspnea, large milky effusions with triglyceride >110

Question 25

Chylothorax pleural effusion treatment

Answer 25

Chest tube (avoid long insertion and drainage), octerotide, TPN or feedings, Percutaneous trans abdominal thoracic duct blockage, ligation of thorasic duct.