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Y3 Conditions > Pleural Effusion > Flashcards

Pleural Effusion Flashcards

1
Q

Pleural Effusion

What can cause it?

5

A
  • congestive heart failure
  • pneumonia
  • cancer
  • cirrhosis
  • kidney disease
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2
Q

Pleural Effusion

What is a trasudate? Why does it occur?

A

when water leaves the capillaries
- high hydrostatic pressure
- low oncotic pressure

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3
Q

Pleural Effusion

What is an exudate? Why does it occur?

A

when capillary walls become leaky and immune cells / protein leakes out
- inflammation

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4
Q

Pleural Effusion

How can we divide exudate effusions?

A
  • parapneumonic effusions
  • malignant effusions
  • inflammatory effusions
  • chylous effusions.
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5
Q

Pleural Effusion

How do we manage a pleural effusion in an emergency?

A

ABCDE to stabilise

If unstable, stabilize their airway, breathing, and circulation. Next, obtain IV access and provide supplemental oxygen, if needed. Finally, put your patient on continuous vital sign monitoring, including heart rate, blood pressure, and pulse oximetry.

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6
Q

Pleural Effusion

How do we manage pleural effusion when a pt is stable?

A

acute management:
- obtaining IV access
- providing supplemental oxygen
- initiating continuous vital sign monitoring

Next, you should perform a focused history and physical, and order labs, including a CBC.

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7
Q

Pleural Effusion

What is the typical presentation?

A
  • cough
  • SOB
  • pleuritic chest pain
  • ± fever
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8
Q

Pleural Effusion

What are some physical exam findings?

A
  • dullness to chest percussion
  • decreased tactile fremitus
  • absent basilar breath sounds on the affected side.
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9
Q

Pleural Effusion

What might CBC show?

A

leukocytosis

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10
Q

Pleural Effusion

What are some imaging studies we can order?

A
  • CXR
  • POCUS
  • CT
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11
Q

Pleural Effusion

What might a CXR show?

A
  • blunting of the cardiophrenic and costophrenic angles
  • meniscus sign

A chest X-ray might not show a pleural effusion until at least 250 ml of fluid has accumulated.

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12
Q

Pleural Effusion

What position of x-ray might better show a small effusion on a CXR?

A

lateral decubitus
might also help you determine if the fluid is loculated

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13
Q

Pleural Effusion

What might you see on POCUS?

A
  • a fluid-filled, or anechoic, collection just above the diaphragm
  • a spine sign

can detect as little as 5 mL

a spine sign, which refers to the visualization of the part of the thoracic spine due to the presence of fluid that is typically obscured by air in the lungs.

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14
Q

Pleural Effusion

What might we use a CT for?

A

find the underlying cause, and aid in potential treatment such as thoracentesis or chest drains

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15
Q

Pleural Effusion

What are some physical exam findings of CHF?

A

tachypnea, jugular venous distension, peripheral edema, rales, or an S3 heart sound

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16
Q

Pleural Effusion

How do we manage CHF?

A

diuretics

17
Q

Pleural Effusion

If a pt with CHF does not response to diuretics, what is the next step?

A

if your patient has an inadequate response, with no reduction of pleural fluid, proceed with a therapeutic thoracentesis.

18
Q

Pleural Effusions

Large effusions may reaccumulate despite therapeutic thoracentesis. If this is the case, what might the next step be for your pt?

A

your patient may need to be evaluated by the surgery team for a chest tube or video-assisted thoracoscopic surgery, or VATs for short.

19
Q

Pleural Effusion

If a pt does not have CHF, what do we do?

A

proceed with diagnostic and therapeutic thoracentesis

This includes removing accumulated fluid from the pleural cavity, and sending it for lab analysis.

20
Q

Pleural Effusion

What do we investigate for in the pleural fluid and why?

A

a cell count with differential, total protein, LDH, glucose, and cholesterol and triglycerides. At the same time, order serum total protein and LDH.

21
Q

Pleural Effusion

What criteria do we use to determine if the fluid is an exudate or a transudate?
What are the specific criteria?

A

Light’s criteria

22
Q

Pleural Effusion

What are the values that differentiate a transudate or exudate?

A
23
Q

Pleural Effusion

What conditions might cause a transdute?

A

CHF, cirrhosis, or nephrotic syndrome

24
Q

Pleural Effusion

If a pt has a transudate, but its not clear if they have CHF, what do you do?

A

order a test called the pleural NT-proBNP.

If the value is greater than 1300 to 4000 pg/mL, it confirms a CHF diagnosis.

25
Q

Pleural Effusion

If a pt has a transudate, and they dont have CHF, what might be the cause?

A
  • hypoalbuminemia
  • hepatic hydrothorax
  • peritoneal dialysis.
26
Q

Pleural Effusion

When does an exudate occur?

A

increased capillary permeability and compromised lymphatic drainage.

27
Q

Pleural Effusion

What might cause an exudative effusion?

A
  • malignancy
  • pneumonia
  • tuberculosis
  • ARDS
  • pancreatitis
  • trauma
28
Q

Pleural Effusion

What investigations do we use to determine the type of exudate?

A

additional pleural fluid studies like cytology and gram stain.
You may also need to order pleural fluid amylase and rheumatoid factor.

29
Q

Pleural Effusion

What would the lab findings of a parapneumonic effusion be like?

A

Cytology: -ve malignant cells
Gram stain: +ve
Cell count: elevated WBCs with a neutrophil predominance.
Glucose is usually low
pleural fluid LDH is high, often above 1000 IU/L
pleural protein is elevated.

30
Q

Pleural Effusion

What does the pH of a parapneumonic effusion mean?

A
  • a pH higher than 7.2 means uncomplicated parapneumonic effusion
  • a pH lower than 7.2 indicates complicated parapneumonic effusion.
31
Q

Pleural Effusion

When might you suspect TB for the cause of an effusion and what might you then go on to test for it?

A

if the pleural protein is extremely high -> think TB

test adenosine deaminase (ADA) levels in the pleural fluid.

32
Q

Pleural Effusion

What would the lab findings of a malignant effusion be like?

A
  • Cytology: +ve malignant cells
  • Gram stain: -ve
  • Cell count: increased WBCs with a lymphocyte predominance.
  • The glucose might be decreased
  • pleural LDH is typically elevated, often over 1000 IU/L.
33
Q

Pleural Effusion

What would the lab findings of an inflammatory effusion be like?

A

Cytology: no malignant cells
Gram stain: -ve
The cell count: elevated WBCs

34
Q

Pleural Effusion

What might cause an inflammatory exudative effusion?
What other markers might differentiate each cause?

A
  • pancreatitis + ARDS
    the pleural fluid amylase might be elevated.
  • autoimmune diseases: SLE / RA
    rheumatoid factor could be positive
35
Q

Pleural Effusion

What would the lab findings of a chylous effusion be like?

A

Cytology: no malignant cells
Gram stain: -ve

  • raised cholesterol + triglycerides are often elevated
  • milky-white pleural fluid,
36
Q

Pleural Effusion

What causes a chylous effusion?

A

chylothorax
(leakage of lymphatic fluid into the thoracic cavity)

37
Q

Pleural Effusion

What is the presence of amylase in the pleural fluid diagnostic of?

A

esophageal rupture

38
Q

Pleural Effusion

How can we use the haemocrit to diagnise haemothorax?

A

pleural fluid hematocrit >0.5x serum hematocrit

Y3 Conditions (55 decks)

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