PLeural effusion Flashcards
2 classifications of pleural effusion depending on the protein concentration
transudate <30g/L
exudate >30g/L
Causes of transudate pleural effusion
heart failure
hypoalbuminaemia
liver disease
nephrotic syndrome
malabsorption
hypothyroidism
Meigs’ syndrome
Causes of exudative pleural effusion
infection (pnuemonia/TB)
subphrenic abscess
connective tissue (RA/SLE)
lung ca/mesothelioma/mets
pancreatitis
PE
Dressler’s syndrome
yellow nail syndrome
Clinical features of pleural effusion (history and on examination)
SOB
dry cough
chest pain
O/E:
dullness to percussion
reduced breath sounds
reduced chest expansion
Imaging used to assess pleural effusion
CXR
US before aspiration
Contrast CT to look for underlying cause
What investigations should be requested on the flui from a pleural aspiration or “tap”
pH
protein
lactate dehydrogenase (LDH)
cytology and microbiology
Light’s Criteria (1972) toHow do we distinguish between transudate/exudate pleural effusions in borderline cases (i.e. if protein level is 25-35g/L)
Lights criteria
It is an exudate if:
- 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
Low glucose in pleura fluid could indicate what diagnoses?
- Rheumatoid arthritis
- tuberculosis
Raised amylase in pleural fluid could indicate what diagnoses?
- pancreatitis
- oesophageal perforation
Heavy blood staining in the pleural fluid could indicate which diagnoses?
mesothelioma
pulmonary embolism
tuberculosis
In which patients should a chest drain be placed after pleural fluid aspiration?
- Fluid is purulent or turbid/cloudy
- Fluid is clear but pH is <7.2 with suspected pleural infection
Management of recurrent pleural effusions
recurrent aspiration
pleurodesis
indwelling pleural catheter
Symptomatic drug Tx:
e.g. opioids to relieve dyspnoea
