Pleural Effusion

Question 0

What is the pleural cavity?

Answer 0

The potential space between the visceral and parietal (outer) pleura.

Question 1

Most common cause of effusion? And what is it’s mechanisms?

Answer 1

LHF -> fluid in IS -> exit across the visceral layer -> parietal pleura can not overwhelm lymph drainage

Question 2

What is the mechanism for hepatic hydro thorax?

Answer 2

cirrhosis -> ascites -> leakage of fluid through diaphragm into pleural space -> usually R sided.

Question 3

What is an empyema?

Answer 3

A collection of pus (inflammatory cells from infectious) in an anatomical cavity.

Question 4

What is the mechanism of a para-pneumonic effusion?

Answer 4

Pneumonia spreads to visceral pleura -> exudate leaking into pleural space -> +/- empyema

Question 5

What are the types of pleural effusions and their classification?

Answer 5

Transudative

• HF APO
• cirrhosis -> ASCITES
• nephrotic syndrome/renal failure
• atelectasis

Exudative

• resp: pneumonia, pe, lung cancer, TB
• rheum: SLE RA
• cancer
• pancreatitis

Question 6

What is thoracocentesis? What are the indications and contraindications?

Answer 6

Procedure to remove either fluid or air using a cannula.

Indications - pleural effusion
Contraindications - emphysema, use of PEEP, only one lung due to reduced reserve

Question 7

What initial Ix?

Answer 7

CBE EUC LFTs
CXR
DIAGNOSTIC THORACOCENTESIS
- protein - cytology (malignancy) - glucose (low in RA, SLE, pneumonia, malignancy), LDH

Question 8

What is the difference between Transudative and exudate?

Answer 8

Transudate - pressure infiltration, without capillary injury

Exudate - inflammatory fluid leaking between cells

Question 9

What is lights criteria?

Answer 9

Distinguishes between Transudative vs exudative.
More likely exudative if:
- ratio of pleural to serum protein > .5
- ratio of pleural to serum LDH > .6
- pleural LDH greater than 2/3 serum pulled limit of LDH.