Pleural effusion Flashcards
What is a pleural effusion?
A pleural effusion is a collection of fluid in the pleural space
What is the difference between exudative and transudative pleural effusion?
Exudative effusion has a higher protein content (>30g/L), whereas transudative effusion has a lower protein content (<30g/L)
What are the causes of transudative effusion?
Heart failure
Cirrhosis
Hypothyroidism
Meigs syndrome
What are the causes of exudative effusion?
Malignancy
Pneumonia
Rheumatoid arthritis
TB
What is Meigs syndrome?
A triad of a benign ovarian tumour, pleural effusion and ascites
What is the presentation of pleural effusion?
Shortness of breath
Cough
Pleuritic chest pain
What examination findings may be seen in pleural effusion?
Reduced chest expansion and breath sounds on affected side
Decreased tactile or vocal fremitus
Dullness to percussion
Pleural friction rub
Tracheal deviation in very large effusions
What is the initial investigation for pleural effusion?
CXR
What is seen on CXR in pleural effusion?
Blunting of costophrenic angle
Fluid in the lung fissures
Large effusions will have a meniscus
Tracheal and mediastinal deviation
What tests can be performed under pleural fluid analysis?
pH
Protein
LDH
Culture and staining
Cytology
What is Light’s criteria?
If protein levels is 25-35 g/, Light’s criteria should be applied:
An exudate is more likely if:
- Pleural fluid protein divided by serum protein is > 0.5
- Pleural fluid LDH divided by serum LDH is > 0.6
- Pleural fluid LDH is more than 2/3 of the upper limit of normal serum LDH
What is the management of pleural effusion?
Treat underlying cause
Thoracentesis
Chest tube drainage
What is empyema?
Empyema is an infected pleural effusion
When should empyema be suspected?
In a patient with an improving pneumonia, but a new or ongoing fever
