Pleural Effusion Flashcards
What is a pleural effusion?
A pleural effusion is the abnormal accumulation of fluid in the pleural space.
What are the types of pleural effusion?
Types include transudative and exudative pleural effusions.
What is the difference between transudative and exudative effusions?
Transudative effusions are caused by systemic factors (e.g., heart failure), while exudative effusions result from local factors (e.g., infection, malignancy).
What are the common causes of transudative pleural effusion?
Causes include heart failure, liver cirrhosis, and nephrotic syndrome.
What are the common causes of exudative pleural effusion?
Causes include pneumonia, malignancy, tuberculosis, and pulmonary embolism.
What are the symptoms of a pleural effusion?
Symptoms include dyspnoea, pleuritic chest pain, and cough.
What are the signs of a pleural effusion on examination?
Signs include reduced chest expansion, stony dullness to percussion, diminished breath sounds, and decreased vocal resonance.
What is the pathophysiology of a pleural effusion?
It involves an imbalance in fluid production and resorption due to increased hydrostatic pressure, decreased oncotic pressure, or increased capillary permeability.
What investigations are used to diagnose pleural effusion?
Investigations include chest X-ray, ultrasound, and diagnostic thoracocentesis.
What are the key chest X-ray findings in pleural effusion?
Findings include blunting of the costophrenic angles, a meniscus sign, and, in large effusions, mediastinal shift away from the affected side.
What is thoracocentesis?
Thoracocentesis is a procedure to sample or remove fluid from the pleural space for diagnostic or therapeutic purposes.
What tests are performed on pleural fluid after thoracocentesis?
Tests include protein levels, LDH, pH, glucose, cytology, microbiology, and cell count.
What criteria are used to differentiate transudative and exudative effusions?
Light’s criteria, which assess pleural fluid protein, LDH, and their ratios to serum levels.
What are the Light’s criteria for exudative pleural effusion?
Pleural fluid is exudative if it meets one or more of the following: pleural protein/serum protein ratio >0.5, pleural LDH/serum LDH ratio >0.6, or pleural LDH >2/3 of the upper limit of normal serum LDH.
What is the role of pleural ultrasound?
Pleural ultrasound is used to confirm the presence of fluid, guide thoracocentesis, and identify septations or loculations.
What is the management of a small pleural effusion?
Small effusions may resolve spontaneously and can be managed conservatively with observation.
What is the management of a large or symptomatic pleural effusion?
Management includes therapeutic thoracocentesis or insertion of a chest drain.
What are the complications of untreated pleural effusion?
Complications include infection (empyema), fibrosis, and respiratory compromise.
What is empyema?
Empyema is a collection of pus in the pleural space, often resulting from untreated or poorly managed infections.
What is the role of chest CT in pleural effusion?
Chest CT helps identify the underlying cause, assess loculated effusions, and detect associated abnormalities like malignancy.
What is a malignant pleural effusion?
A malignant pleural effusion is caused by cancer, commonly lung, breast, or lymphoma, and often recurs despite treatment.
How is a malignant pleural effusion managed?
Management may include repeated thoracocentesis, indwelling pleural catheters, or pleurodesis to prevent fluid re-accumulation.
What lifestyle modifications can help prevent recurrent pleural effusions?
Modifications depend on the underlying cause, such as better management of heart failure or cirrhosis.
What are the differential diagnoses for pleural effusion?
Differential diagnoses include pneumonia, congestive heart failure, pulmonary embolism, and malignancy.
What is the prognosis for pleural effusion?
Prognosis depends on the underlying cause, with transudative effusions often resolving with treatment of the primary condition and exudative effusions requiring targeted therapy.
