pleural effusion Flashcards
define pleural effusion
collection of fluid between parietal and visceral pleura or in the pleural cavity of the thorax.
what are the 2 main types of pleural effusion
- transudative
- exudative
what causes transudative pleural effusion
the flluid shifts due to an increase in hydrostatic pressure or oncotic pressure.
what causes exudative pleural effusion
fluid shifts due to inflammation
Inflammation causes an increase in vascular permeability causing fluid + protein to leak moving across into the pleural space.
examples of transudative pleural effusion
- Congestive HF
- Fluid overload
- Hypoalbuminemia (cirrhosis, nephrotic syndrome)
examples of exudative pleural effusion
- cancer
- TB
- pneumonia
- lung cancer
describe protein count in both transudative and exudative pleural effusion
transudative - LOW PROTEIN COUNT (<25g/l)
exudative - HIGH PROTEIN COUNT (>35g/l)
what is lights criteria
used when protein is between 25 and 35 g/l
(grey area)
appearance of transudative pleural fluid
transparent
appearance of exudative pleural effusion
cloudy
symptoms of pleural effusion
- SOB
- Cough
- pleuritic chest pain
- Stony dull percussion over effusion
- Reduced breath sounds
- Tracheal deviation away from the effusion if it’s a large pleural effusion.
investigations for pleural effusion
- chest x ray - 1st line & gold standard
- Pleural ultrasound
- Thoracocentesis
what does chest x ray for pleural effusion show
will see ‘blunting’ of the costophrenic angles.
excess fluid appears white
what is throacocentesis
sampling pleural fluid
identifies and diagnoses underlying cause
how to treat pleura effusion
Usually dependent on cause
- Congestive HF – Loop diuretics
- Infective – Antibiotics
- Malignant - Therapeutic thoracentesis
- Treatment for large effusions - CHEST DRAIN -> 5th intercostal space
