Pleural effusion

Question 1

Pleural effusion definition

Answer 1

• accumulation of fluid between parietal and visceral layers of pleura in thorax

Question 2

Transudative pleural effusion

Answer 2

• too much fluid leaves capillaries
• due to increased hydrostatic (pushing out e.g. heart failure) or decreased oncotic pressure (protein cannot enter therefore fluid leaves pleural space, e.g. cirrhosis or nephrotic syndrome)

Question 3

Exudative pleural effusion

Answer 3

• inflammation of pulmonary capillaries
• leads to leaking of fluid
• caused by trauma, malignancy, inflammatory conditions, infections

Question 4

Light’s criteria

Answer 4

one or more of the following suggest an exudate:
- pleural fluid protein divided by serum protein >0.5
- pleural fluid LDH divided by serum LDH > 0.6
- pleural fluid LDH > two-thirds of the upper limit of normal range for serum LDH

Question 5

Pleural effusion signs and symptoms

Answer 5

• dyspnoea
• cough
• pleuritic chest pain
• reduced breath sounds
• decrease in vocal transmission at base of lung

Question 6

Pleural effusion investigations

Answer 6

• CXR, PA view
• thoracic ultrasound for assessment
• thoracocentesis/aspiration for diagnosis
• consider CT thorax

Question 7

Pleural effusion management

Answer 7

• consider oxygen
• loop diuretics e.g. furosemide for heart failure
• treat infections with antibiotics
• consider therapeutic drainage, may be useful in malignancy