Pleural Effusion

Question 1

Causes of pleural effusion

Answer 1

1) too much fluid: CHF, hyponatremia, parapneumonic effusions, hypersensitivty rxns
2) too little resorption fo fluid: tumor+ lymphatic blockage, elevated CVP, dec. intrapleural pressure
3) transport from peritoneal cavity: ascites

Question 2

dressler syndrome

Answer 2

-post MI syndrome
2-3 wks after transmural MI –> left pleural effusion, pericardial effuision, patchy airspace disease at left lung base
-presents w/: chest pain + fever; responds to high dose aspirin / steroids

Question 3

transudate vs. exudate

Answer 3

-transudate: incr. capillary pressure / dec. osmotic pressure –> low protein (CHF, cirrhosis, nephrotic syndrome, hypoalbuminemia)
exudate = high protein; malignancy = most common cause; another ex. of exudate = empyema (pus); hemothorax = hematocrit > 50%;

Question 4

loculated effusions:

Answer 4

adhesions in the pleural space, often due to empyema / hemothroax –> effusion has the same position no matter what the patient’s position is (difficult to drain)

Question 5

fissural pseudotumors

Answer 5

sharply marginated collections of pleural fluid (transudative; typically CHF patients)

Question 6

hydropneumothorax

Answer 6

no meniscoid shape
straight edge + sharp air over fluid interface
caused by surgery, trauma, recent thorocentesis, brochopleural fistula

Question 7

where do pleural effusions collect?

Answer 7

in the potential space b/w visceral + parietal pleura

Question 8

what is contained in a pleural effusion?

Answer 8

transudate or exudate depending on: 1) protein content 2) LDH concentration

Question 9

where do you look for laminar effusion?

Answer 9

above lung bases by the costophrenic angle