Pleural effusion

Question 1

what is pleural effusion

Answer 1

fluid in the pleural space

Question 2

what can effusions be divided into

Answer 2

transudates and exudates

Question 3

what is the level of protein in transudate

Answer 3

<25g/L

Question 4

what is the level of protein in exudate

Answer 4

> 35g/L

Question 5

what is the term for blood in the pleural space

Answer 5

haemothorax

Question 6

what is the term for pus in the pleural space

Answer 6

empyema

Question 7

what is the term for chyle (lymph with fat) in the pleural space

Answer 7

chylothorax

Question 8

what is the term for blood and air in the pleural space

Answer 8

haemopneumothorax

Question 9

what can transudates be due to

Answer 9

increased venous pressure, hypoproteinaemia. can also occur in hypothyroidism and Meigs syndrome (right pleural effusion and ovarian fibroma)

Question 10

examples of increased venous pressure

Answer 10

cardiac failure, constrictive pericarditis, fluid overload

Question 11

examples of hypoproteinaemia

Answer 11

cirrhosis, nephrotic syndrome, malabsorption

Question 12

what are exudates due to

Answer 12

increased leakiness of pleural capillaries secondary to infection, inflammation, malignancy

Question 13

causes of exudates

Answer 13

pneumonia, TB, pulm infarction, RA, SLE, bronchogenic carcinoma, malignant mets, lymphoma, mesothelioma

Question 14

symptoms of effusion

Answer 14

aymptomatic, or dyspnoea, pleuritic chest pain

Question 15

signs of effusion

Answer 15

decreased expansion, STONY dull percussion note, diminished breath sounds on affected side, decreased tactile frennitus and vocal resonance. bronchial breathing, tracheal deviation (if large effusion), aspiration marks and signs associated illness

Question 16

what does the CXR show in small effusion

Answer 16

blunting of the costodiaphragmatic angle

Question 17

what does the CXR show in a larger effusion

Answer 17

water dense shadows with concave upper borders

Question 18

what does a completely flat horizontal upper border imply

Answer 18

pneumothorax

Question 19

what other tests are useful other than CXR

Answer 19

ultrasound, diagnostic aspiration, pleural biopsy

Question 20

what would you send the pleural fluid in an aspiration to the lab for

Answer 20

clinical chem (protein, glucose, pH, LDH, amylase); bacteriology (microscopy and culture, auramine stain, TB culture); cytology; immunology (rheumatoid factor, ANA, complement)

Question 21

management

Answer 21

drainage (if symptomatic- slowly- 0.5-1.5L/24h-> diagnostic tap or intercostal drain); pleurodiesis (tetracycline, bleomycin, talc); intra pleural streptokinase; surgery

Question 22

pleural fluid analysis: clear, straw coloured

Answer 22

transudate, exudate

Question 23

pleural fluid analysis: turbid, yellow

Answer 23

empyema, parapneumonic effusion

Question 24

pleural fluid analysis: haemorraghic

Answer 24

trauma, malignancy, pulm infarction

Question 25

pleural fluid analysis: neutrophils ++

Answer 25

parapneumonic effusion, PE

Question 26

pleural fluid analysis: lymphocytes ++

Answer 26

malignancy, TB, RA, SLE, sarcoidosis

Question 27

pleural fluid analysis: mesothelial cells ++

Answer 27

pulm infarction

Question 28

pleural fluid analysis: abnormal mesothelial cells

Answer 28

mesothelioma

Question 29

pleural fluid analysis: what does hypoglycaemia (0.6) show

Answer 29

empyema, malignancy, TB, RA, SLE

Question 30

pleural fluid analysis: what does a high amylase show

Answer 30

pancreatitis, carcinoma, bacterial pneumonia, oesophageal rupture