Pleural Effusion Flashcards
What is pleural effusion?
Collection of fluid in pleural space
How are pleural effusions categorised?
Exudative - high protein content >30g/L
Transudative - lower protein count <30g/L
What is used to establish an exudative effusion?
Light’s criteria
Define light’s criteria
Pleural fluid protein/serum protein >0.5
Pleural fluid LDH/serum LDH > 0.6
Pleural fluid LDH / serum protein > 0.5
Pleural fluid LDH > 2/3 of normal upper limit of serum LDH
What are the caused of an exudative pleural effusion?
Inflammation -> protein leaking out of tissues into pleural space
-cancer
-infection
-RA
What are the causes of transudative pleural effusion?
Congestive cardiac failure
Hypoalbuminaemia
Hypothyroidism
Meigs syndrome
What is the main presenting symptom?
SOB
What is seen on examination?
Dullness to percuss
Decreased breath sounds
Tracheal deviation away from affected side
What are the x ray findings?
Blunting of costophrenic angle
Fluid in lung fissures
Large effusion will have meniscus
Tracheal and mediastinal deviation away from large effusions
What other investigations can be done?
US and CT
Pleural fluid analysis
What is the treatment?
Conservative management
Pleural aspiration
Chest drain
What is an empyema?
Infected pleural effusion
When should you suspect an empyema?
Improving pneumonia, with new or ongoing fever
What is seen on pleural aspiration in empyema?
Pus, low pH, low glucose and high LDH
How are empyemas treated?
Chest drain and antibiotics
