Pleural Effusion Flashcards
Pleural effusion diagnostics
CT, CXR, ultrasound
May need thoracentesis with chest tube and analysis
Transudative causes of pleural effusion
CHF, Cirrhosis, Nephrotic syndrome, peritoneal dialysis, SVC obstruction, myxedema, urinothorax
Exudative causes of pleural effusions
Neoplastic diseases, infectious diseases, pulmonary embolism or infarction, trauma
What indicated exudative fluid on a pleural fluid analysis
Protein/serum protein <0.5
LDH/ Serum LDH >0.6
LDH>2/3 normal upper serum limit
What indicates Transudative pleural fluid on analysis
Serum protein/pleural fluid protein gradient >3.1
What does a low glucose <60 on exudative pleural fluid indicate
Malignancy vs bacterial infection vs rheumatoid pleuritis
If pleural fluid analysis comes back negative consider what cause?
PE
If pleural a fluid analysis is negative and PE is negative consider what cause?
TB
If pleural fluid analysis and PE and TB work up is negative what is the next step?
Thorascopy or pleural biopsy
Absolute pleural fluid findings that indicate a need for complete drainage
pH<7.2, gluocse <60, LDH>1000, bacteria present
What is the most common cause of pleural effusions
Heart failure
What is the presentation for pleural effusions d/t HF
Not bilateral, febrile, pleuritic chest pain
Pleural fluid ProBNP >1500
Treatment plan for pleural effusions due to heart failure
Treat underlying HF with possible thoracentesis
What is the predominant mechanism for pleural effusions caused by hepartic hydrothroax
Direct movement of peritoneal fluid into the plural space causing a right sided effusion
What is the most common exudative pleural effusion cause
Parapneumonic
What are the underlying causes of parapneumonic pleural effusions
Bacterial pneumonia, lung abscess, or bronchiectasis
S/S of aerobic vs anaerobic vs empyema of parapneumonic pleural effusions
Aerobic: acute febrile, chest pain, sputum production, leukocytosis
Anaerobic: subacute illness, weight loss, mild anemia, aspiration
Empyema: grossly purulent effusion
Treatment of pleural effusions caused by parapneumonic including recurrent infections
Effusion >10mm: thoracentesis
-pH <7.2, Glucose <60, gram stain +: invasive approach
If reoccurrence may need chest tube with TPA
Thoracoscopy
Decorticating
Second most common cause of exudative effusions
Malignancy of lung, breast, or lymph
S/s of pleural effusion caused by malignancy
Dyspnea out of proportion, ctyology
Pleural effusion caused by malignancy treatment
Symptomatic relief
Thoracostomy tube
Sclerosing agent like doxycycline
What is the etiology of pleural effusions caused by chylothroax
Disruption of the thorasic duct accumulating chyle
Most common causes of chylothorax pleural effusions
Trauma from thoracic surgery, mediastinal tumors
S/s of chylothorax pleural effusions
Dyspnea, large milky effusions with triglyceride >110
Chylothorax pleural effusion treatment
Chest tube (avoid long insertion and drainage), octerotide, TPN or feedings, Percutaneous trans abdominal thoracic duct blockage, ligation of thorasic duct.
