PLEURAL EFFUSION

Question 1

What is a pleural effusion?

Answer 1

Excess fluid accumulation in the pleural space.

Question 2

What are the symptoms of pleural effusion?

Answer 2

 Pleuritic chest pain (pleurisy)
 SOB
 Haemoptysis
 Cough

Question 3

What types of fluid can be part of an effusion?

Answer 3

1. Transudate
2. Exudate
3. Pus
4. Blood
5. Chyle (thoracic duct)
6. Urine
7. Cholesterol

Question 4

What can cause a pleural effusion?

Answer 4

 CCF
 Hypoproteinemia: cirrhosis or nephrotic syndrome
 Hypothyroidism
 Infection
 Inflammation (including rheumatoid arthritis and SLE)
 Malignancy
 Trauma

Question 5

What are the 3 mechanisms that can lead to a pleural effusion?

Answer 5

1. Increased hydrostatic pressure
2. increased permeability
3. decreased oncotic pressure

Question 6

What is the treatment/management of pleural effusion?

Answer 6

Drainage, pleurodesis, treat underlying cause

Question 7

what will you find on examination?

Answer 7

 Decreased chest expansion
 Decreased breath sounds
 Dull percussion

Rare: tracheal deviation

Question 8

What investigations need to be ordered?

Answer 8

1. CXR
2. US may be useful if loculated effusion is present and in guiding drainage/thorocentesis
3. CT can show underlying lung pathology
4. Biochemistry
5. MCS
6. Immunology
7. Cytology
8. Bronchosocopy
9. Thorocoscopy

**see notes for more detailed explanation

Question 9

what do loculations in pleural effusion indicate?

Answer 9

Empyema

Question 10

what does a low glucose and low pH indicate?

Answer 10

Infection or malignancy

Question 11

what does a high LDH and protein indicate?

Answer 11

Exudate