Pleural effusion Flashcards
What is pleural effusion?
Fluid collecting between parietal + visceral pleura
What are the 2 types of fluid pleural effusions can be classified upon?
Transudate: <30g/L protein
Exudate: >30g/L protein
What mechanism causes an exudate?
Inflammation causes increased permeability of pleural capillaries- leaking intravascular fluid (cells, their contents + proteins)
What mechanism causes a transudate?
Hydrostatic forces cause extravasation of fluid through a normal membrane
Give 4 causes of transudative pleural effusion
HF (most common)
Hypoalbuminaemia
Hypothyroidism
Meig’s syndrome
Give 3 causes of hypoalbuminaemia
Liver disease
Nephrotic syndrome
Malabsorption
Give 7 causes of exudative pleural effusion
Infection
Malignancy
CTDs: RhA + SLE
PE
Pancreatitis
Dressler’s syndrome
Yellow nail syndrome
Give 3 infectious causes of pleural effusion
Pneumonia (most common exudative cause)
TB
Subphrenic abscess
List 3 types of malignancy that can cause exudative pleural effusion
Lung cancer
Mesothelioma
Mets
What criteria is used to determine if the fluid is an exudate?
Light’s criteria
Ratio of pleural fluid to serum protein >0.5
Ratio of pleural fluid to serum LDH >0.6
Pleural fluid LDH >2/3 the upper limit of normal serum value
What is indicated by frankly purulent fluid?
Empyema
What is indicated by milky fluid? What is this likely caused by?
Chylothorax or pseudochylothorax
Lymphatic obstruction secondary to malignancy, chronic inflammation or thoracic duct injury
What is indicated by bloody fluid?
Trauma
(Less commonly TB, PE, aortic dissection, ruptured aortic aneurysm, malignancy)
What does the presence of food particles indicate?
Oesophageal rupture
What is black pleural fluid indicative of?
Extremely rare!
Aspergillus niger infection
Malignant melanoma
Haemorrhage + haemolytic a/w non-small cell lung cancer