pleural effusion Flashcards
causes of transudate and exudate effusions?
transudate: HF, liver cirrhosis, nephrotic syndrome
exudate:
1. infections
-pneumonia (parapneumonic effusion)
-pulmonary TB
-empyema
- malignancies
-lung cancer
-mesothelioma
-metastatic breast cancer
-ovarian cancer - pulmonary embolism (can cause both but commonly exudate)
- autoimmune dx
-SLE
-RA
symptoms?
dry cough
SOB
pleuritic chest pain
physical exam:
-reduced chest expansion on effected side
-absent or faint breath sounds on area
-stony dull percussion note on area
-bronchial breathing ABOVE the effusion
-reduced tactile fremitus
diagnosis?
chest xray
-homogenous opacity obliterating the costophrenic angle with meniscus sign
pleural tapping (dx and therapeutic) with US guided, and it’s done as long as not transudate causes
-send for protein, LDH, pH (<7.2 in empyema), cell count, gram stain and culture, acid-fast bacili stain, cytology, lipid profile (high TG in chylothorax), amylase (high in pancreatitis)
CT with contrast if previous tests dont provide diagnosis
gold standard is pleural biopsy
light’s criteria?
uses total protein and LDH to differentiate exudate from transudate effusions.
it’s exudate if:
pleural effusion proteins > 0.5 of serum
pleural effusion LDH > 0.6 of serum
pleural LDH is more than 2/3 upper limits of normal serum LDH
VERY HIGH LDH (>1000) suggests empyema or malignancy
how to know hemothorax vs hemorrhagic pleural effusion?
do pleural:serum hematocrit
if >50 hemothorax
<50 hemorrhagic pleural effusion
