Pleural Effusion Flashcards
Normal amount of fluid in a pleural space?
5-25 ml
What is the pleural space?
a potential space/serous membrane between the thin visceral and parietal pleura
Normal movement of pleural fluid
Made by parietal pleura, absorbed by visceral pleura
Should eb virtually fluid free
Three basic ways to get a fluid into the pleural space
Increased drainage of fluid in
Increades production by cells in the space
Decreased drainage from the space
Defects that could alter the fluid homeostasis of the pleural cavity, causing effusion (8)
Increased Capillary hydro. pressure (CHF)
Increased capillary permeability (Pneumonia)
Increased intrapleural pressure (atelectasis)
Decreased plasma oncotic pressure (hypoalbuminemia)
Decreased pleural mem. permeab. (malignancy)
Increased lymphatic obstruction (malignancy)
Diaphragmatic Defect (hepatic hydrothorax)
Thoracic Duct Rupture (Chylothorax)
ID the fluid found in….
Hydrothorax, Hemothorax, Chylothorac, Empyema
Hydro - Serous
Hemo - Blood
Chylo – Milk-like (lymphatics)
Empyema - Pus
Causes of transudative pleural effusion?
CHF, Cirrhosis, Nephrotic Syndrome, Constrictive pericarditis, peritoneal dialysis
Causes of exudative pleural effusion?
PARAPNEUMONIC + TB Connective Tissue Disorders Malignancy Pancreatitis Subphrenic Abscess Dengue Radiation Pleuritis
Causes of chylous pleural effusion?
Congenital
Post-traumatic
Post-malignancy
Causes of hemothorax
Blunt trauma
Malignancy
Top 4 most common causes of pleural effusion
CHF
Pneumonia
Cancer
PE
Physical exam findings associated with pleural effusion?
Dullness to percussion Decreased tactile fremitus Asymmetric expansion Decreased breath sounds Egophony
How to diagnose pleural effusion?
CXR (Lateral decubitus most sensitive)
Pleural fluid analysis
Chest US
CT scan (fluid, abscess, or tumor)
Fluid in Xray is seen as…
Dense, White Shadow with a concave upper edge
How do heart/mediastinum move in response to atelectasis? effusion?
TOWARD ATELECTASIS
AWAY FROM HEMOTHORAX
Indications for thoracentesis?
Unilateral effusion, asymmetric bilateral
Evidence of pleurisy/fever
No response to diuresis in 2-3 days
Effusion out of proportion to clinical setting
How is thoracentesis performed?
Needly passd through upper border of lower rib to remove 50-100 mL fluid for analysis.
According to Light’s Criteria, how is a fluid labeled as Transudate?
Pleural fluid protein: Serum Protein ration under 0.5
Pleural LDH:serum LDH under 0.6
Pleural fluid LDH is less than 2/3 of serum level (or under 200)
According to Light’s Criteria, how is a fluid labeled as Exudate?
Failure to meet any of the three criteria for transudate
Pleural glucose levels below 3.3 mmol/L (or 1/2 serum glu) indicate…
RA Pleurisy, Empyema, Malignancy, Esophageal Rupture
Lupus, TB
Low pH fluid indicates…
RA Pleurisy, Malignancy, Empyema, Esophageal Rupture
Urinothorax
Significant elevation of lactate (over 90) strongly increased your index of suspicion for…
bacterial/TB pleural infections
Elevated amylase levels (above 1.5-2) indicate the presence of…
pancreatitis
esophageal rupture
malignant effusion
Elevated Adenosine deminase (over 43) indicates…
TB
Elevated IFN-g (over 140 pg/ml) indicates…
TB
Elevated eosinophil values (over 10%) may indicate…
Pneumothorax, Hemothorax, Parasitic/Fungal Infection
Markedly increased numbers of mesothelial cells in bloody/eosinophilic effusions indicate…
PE
Lung cancer most prone to cause effusion
Adenocarcinoma
Most common cancer to cause effusion in young adults
Lymphoma
What is a chylothorax ad what might cause itq
An acute effusion with a normal pleural surface with TG above 110. Its caused by trauma or malignancy.
What is a pseudochylothorax and what might cause it?
Chronic effusion with a thickened pleura. Cholesterol over 200. Can be caused by any chronic effusion (over 6 months)
Typically associated with TB or RA
Labs for pleural effusion patient that gets a chest tube (5 features)
Complicated Fluid is cloudy, pH under 7.2, glucose under 40, LDH over 1000 PMN over 25,000
Causes of chest tube decision
EMPYEMA
Complicated parapneumonic effusion
Hemothorax
Malignant efusion
Three stages of Empyema
Exudative (1-3 days)
Fibrinopurulant (4-14)
Organizational (14+)
