Pleural Effusion Flashcards
What is a pleural effusion ?
Pleural effusion is the accumulation of fluid in between the parietal and visceral pleura, called the pleural cavity. It can occur by itself or can be the result of surrounding parenchymal disease like infection, malignancy, or inflammatory conditions.
what are the two mechanism of pleural effusion ?
Transudative and exudative
What is the modified Lights’s criteria for differentiating transudative vs exudative pleural effusion ?
Modified Light’s criteria classify pleural effusion as exudative if there is any of the following:
*Pleural fluid protein/serum protein ratio of more than 0.5
*Pleural fluid lactate dehydrogenase (LDH)/serum LDH ratio of more than 0.6
*Pleural fluid LDH is more than two-thirds of the upper limits of normal laboratory value for serum LDH.
what are the 3 types of pleural effusion ?
Paraneumonic, empyema, and Haemothorax.
What is know as Paraneumonic pleural effusion ?
It is a non-infected pleural effusion secondary to pneumonia
(bacterial or viral).
What is empyema ?
It is a pus forming pleural effusion due to direct infection of the pleural space.
What is Haemothorax ?
It is collection of blood in the pleural space.
What are the symptoms of pleural effusion ?
The symptoms depends on the size of the effusion. If the effusion is small the patient can be asymptomatic. If it is large Patient may present with pleuritic chest pain, SoB and Cough.
What are the signs of pleural effusion ?
Decreased breath
sounds
* Dullness on percussion
* Decreased tactile
fremitus
* Tracheal deviation if
there is a large
effusion
What is the initial test of choice in pleural effusion ?
Chest X-ray
What are the imaging tests to rule in or out empyema and gain additional information ?
CT and Ultrasound.
What is the gold standard diagnostic test in pleural effusion ?
Thoracentesis
What is a notable sign in Chest radiograph of a patient with pleural effusion ?
Blunting of chostophrenic angle.
What is the management approach in pleural effusion ?
- The main stay of treatment is to treat the underlying disease.
- Thoracentesis although not always needed can be diagnostic and therapeutic.
- Chest tube drainage.
- If chronic or secondary to malignancy surgery is indicated
- Pleurodesis
What is Pleurodesis ?
Pleurodesis is a medical procedure in which part of the pleural space is artificially obliterated. It involves the adhesion of the visceral and the costal pleura with sparing of mediastinal pleura.
What are the common causes of transudative pleural effusion ?
Any pathology that alter starling’s equilibrium of starling’s forces such as CHF, Liver disease, ESRD, Nephrotic syndrome, and pulmonary embolism.
What are the rare causes of transudative pleural effusion ?
- Vascular causes such as Brachiocephalic occlusion and SVC syndrome.
- Trapped lung due to endobronchial lesions or visceral pleural adhesions.
- hypoprteniema due to Central line, CSF, peritoniel dialysis, and urine.
What are the common causes of exudative pleural effusion ?
- Infections, cancer, drugs, autoimmune diseases, and pulmonary embolism.
What are the rare causes of exudative pleural effusion ?
Chylothorax or asbestosis
What are the secondary causes of right sides pleural effusion ?
Meige’s syndrome and endometriosis.
What are the secondary causes of left sides pleural effusion ?
pancreatitis and oesophageal rupture.
What is Pleurisy or pleuritis ?
Pleuritis is an inflammation (swelling or irritation) of the lung pleura .
What are the causes of Pleurisy ?
- bacterial, viral and fungal infections.
- Lung cancers
- Pulmonary embolism
- Autoimmune diseases such as SLE or RA.
- Chest injuries and Mesothelioma.
What are the symptoms of pleuritis ?
- Sharp stabbing pain that causes the patient to do shallow breathing as deep breathing worsens the pain.
- Pain that spreads to the shoulder and the back.
- Cough
