Pleural effusion

Question 1

What is pleural effusion?

Answer 1

Fluid in pleural cavity

Question 2

CXR finding in pleural effusion

Answer 2

Loss of Costo-phrenic angle (CPA)

Question 3

Types of pleural effusion

Answer 3

Transudative - B ilateral
in Liver, heart, kidney failure

Exudative - Unilateral
in Pneumonia, Carcinoma, TB

Question 4

Light criteria

Answer 4

Exudative pleural effusion
LDH and protein in pleural fluid compared with blood

Transudative
LDH <200 IU/ml
LDH/serum LDH <0.6
Protein/serum protein <0.5

Exudative
LDH >200 IU/ml
LDH/serum LDH >0.6
Protein/serum protein >0.5

Question 5

Mx of pleural effusion

Answer 5

1. Small effusion - observe
2. Fluid aspiration/tapping (NO MORE THAN1.5L) - sudden re-expansion may cause pulm oedema
3. Chest drain - empyema/haemothorax

Question 6

Simple vs complicated parapneumonic effusion

Answer 6

Parapneumonic pleural effusion = effusion post pneumonia

Simple:
Transudate
Non loculated

Complicated:
1. Bact infection in pleural space
2. Effusion/empyema
3. loculated
4. d/t Staph aureus, Grp A strep, pneumococcus