Pleural Effusion

Question 1

What is a pleural effusion?

Answer 1

A pleural effusion is the abnormal accumulation of fluid in the pleural space.

Question 2

What are the types of pleural effusion?

Answer 2

Types include transudative and exudative pleural effusions.

Question 3

What is the difference between transudative and exudative effusions?

Answer 3

Transudative effusions are caused by systemic factors (e.g., heart failure), while exudative effusions result from local factors (e.g., infection, malignancy).

Question 4

What are the common causes of transudative pleural effusion?

Answer 4

Causes include heart failure, liver cirrhosis, and nephrotic syndrome.

Question 5

What are the common causes of exudative pleural effusion?

Answer 5

Causes include pneumonia, malignancy, tuberculosis, and pulmonary embolism.

Question 6

What are the symptoms of a pleural effusion?

Answer 6

Symptoms include dyspnoea, pleuritic chest pain, and cough.

Question 7

What are the signs of a pleural effusion on examination?

Answer 7

Signs include reduced chest expansion, stony dullness to percussion, diminished breath sounds, and decreased vocal resonance.

Question 8

What is the pathophysiology of a pleural effusion?

Answer 8

It involves an imbalance in fluid production and resorption due to increased hydrostatic pressure, decreased oncotic pressure, or increased capillary permeability.

Question 9

What investigations are used to diagnose pleural effusion?

Answer 9

Investigations include chest X-ray, ultrasound, and diagnostic thoracocentesis.

Question 10

What are the key chest X-ray findings in pleural effusion?

Answer 10

Findings include blunting of the costophrenic angles, a meniscus sign, and, in large effusions, mediastinal shift away from the affected side.

Question 11

What is thoracocentesis?

Answer 11

Thoracocentesis is a procedure to sample or remove fluid from the pleural space for diagnostic or therapeutic purposes.

Question 12

What tests are performed on pleural fluid after thoracocentesis?

Answer 12

Tests include protein levels, LDH, pH, glucose, cytology, microbiology, and cell count.

Question 13

What criteria are used to differentiate transudative and exudative effusions?

Answer 13

Light’s criteria, which assess pleural fluid protein, LDH, and their ratios to serum levels.

Question 14

What are the Light’s criteria for exudative pleural effusion?

Answer 14

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.

Question 15

What is the role of pleural ultrasound?

Answer 15

Pleural ultrasound is used to confirm the presence of fluid, guide thoracocentesis, and identify septations or loculations.

Question 16

What is the management of a small pleural effusion?

Answer 16

Small effusions may resolve spontaneously and can be managed conservatively with observation.

Question 17

What is the management of a large or symptomatic pleural effusion?

Answer 17

Management includes therapeutic thoracocentesis or insertion of a chest drain.

Question 18

What are the complications of untreated pleural effusion?

Answer 18

Complications include infection (empyema), fibrosis, and respiratory compromise.

Question 19

What is empyema?

Answer 19

Empyema is a collection of pus in the pleural space, often resulting from untreated or poorly managed infections.

Question 20

What is the role of chest CT in pleural effusion?

Answer 20

Chest CT helps identify the underlying cause, assess loculated effusions, and detect associated abnormalities like malignancy.

Question 21

What is a malignant pleural effusion?

Answer 21

A malignant pleural effusion is caused by cancer, commonly lung, breast, or lymphoma, and often recurs despite treatment.

Question 22

How is a malignant pleural effusion managed?

Answer 22

Management may include repeated thoracocentesis, indwelling pleural catheters, or pleurodesis to prevent fluid re-accumulation.

Question 23

What lifestyle modifications can help prevent recurrent pleural effusions?

Answer 23

Modifications depend on the underlying cause, such as better management of heart failure or cirrhosis.

Question 24

What are the differential diagnoses for pleural effusion?

Answer 24

Differential diagnoses include pneumonia, congestive heart failure, pulmonary embolism, and malignancy.

Question 25

What is the prognosis for pleural effusion?

Answer 25

Prognosis depends on the underlying cause, with transudative effusions often resolving with treatment of the primary condition and exudative effusions requiring targeted therapy.