Pleural effusion 2

Question 1

Urinothorax

Answer 1

Due to obstruction - surgical or malignancy cause hydronephrosis and back up into lungs.

Transudate
pH low
Pleural Cr> Serum Cr
Glucose Low

Dx: Renal scintigraphy (99 technichum scan)

Question 2

Peritoneal dialysis Pleural effusion

Answer 2

Within 30 days - >1year of starting PD
Right sided effusion

Glucose very high (due to dialysate)
Low protein
Low LDH

Tx:
- Stop PD 2-6 weeks or smaller exchange volumes
- Can consider surgical VATs

Question 3

Glycinothorax

Answer 3

Bladder irrigation using glycine solutions
with hx of transurethral surgery
perforation of bladder spills into the abdominal cavity and into pleural space

Transduate- high glycine

Question 4

Spontaneous bacterial hydrothorax

Answer 4

Cell count
- NT > 250 with culture positive
- or WBC >500 with culture negative

Question 5

Dresslers Pleural effusion

Answer 5

Fever, pleuritic chest pain.
Small unilateral or bilateral pleural effusion with infiltrate on CXR

Bloody/Serosanguinous
Predominately PMN
pH normal
Glucose normal
Anti-myocardial antibody- elevated

Tx: NSAID, colchicine

Question 6

Dural spinous fistula

Answer 6

After spinal trauma or surgery

Check Beta 2 transferrin (elevated)

Question 7

TB effusion

Answer 7

Exudative

Lymphocytic
Low Glucose
ADA elevated (>40)

If IFN with ADA elevated then suspicion very high.

Biopsy of the pleura: Caseating * granulomas

Question 8

Yellow Nail Syndrome

Answer 8

Triad:
Lymphadema
Chronic respiratory disease (pleural effusions 50% of the time, bronchiectasis, and chronic sinusitis)
Nail abnormalities

Autosomal dominant or sporadic

Pleural fluid: Lymphocytic effusion, possible chylothorax
Pleural biopsy: fibrosis pleuritis

Tx: decortication or pleurodesis

Question 9

Chylothorax

Answer 9

Exudative effusion
- Milky, turbid, chyle in the pleural space from thoracic duct

TG>110
Send chylomicons

Tx: low fat diet, surgical ligation or embolization of lymph system

• think of LAM
• think of yellow nail syndrome

Question 10

Pseudochylous

Answer 10

Cholesteral >220
No chylomicrons
TB, RA, Helminth infxn

Question 11

Bilothorax

Answer 11

Bilious pleural effusion
due to
—- pleurobiliary fistula or
—- bile leakage

Dx:
– exudative effusion with high pH
– Pleural fluid bile > serum bile fluid

Drain
Treat with antibiotics even if negative due to high risk for infection
Fix the defect - whether related to biliary tract or to diaphragm