Pleural Effusion

Question 1

what is P effusion?

Answer 1

an excessive accumulation of fluid in the pleural space

Question 2

what are the causes of transudate?

Answer 2

may be due to increased venous pressure

or hypoproteinaemia

It also occurs in hypothydroidism and Meigs syndrome

Question 3

what can cause increase in venous pressure?

Answer 3

cardiac failure, constrictive pericarditis, fluid overload

Question 4

what causes hypoproteinaemia?

Answer 4

cirrhosis, nephrotic syndrome, malabsorption

Question 5

what are the causes of exudate?

Answer 5

most commonly due to increased leakiness of pleural capillaries secondary to infection, inflammation or malignancy

Question 6

what are some examples of these causes of exudate ?

Answer 6

pneumonia; TB; pulmonary infarction; rheumatoid arthritis; SLE; bronchogenic carcinoma; malignant metastases; lymphoma; mesothelioma; lymphangitis carcinomatosis.

Question 7

what are the symptoms?

Answer 7

worsening dyspnoea
cough
pleuritic pain
or may be asymptomatic

Question 8

what are the signs ?

Answer 8

decreased expansion

stony dull percussion

diminished breath sounds on the affected side

tactile vocal fremitus and vocal resonance are decreased - not as reliable

Question 9

what may be a sign of a large effusion ?

Answer 9

may be tracheal deviation away from the effusion

Question 10

what should also be done on examination

Answer 10

look for signs of associated disease like clubbing cachexia and stuff

Question 11

what investigations should be done?

Answer 11

CXR,

and examination - only detected when more than 500 ml is present

ultrasound may be done

diagnostic aspiration

pleural biopsy

Question 12

what can be seen on CXR of a small effusion?

Answer 12

small effusions blunt the costophrenic angles

Question 13

what can be seen on CXR of a larger effusion?

Answer 13

they are seen as water dense shadows with concave upper borders

Question 14

what does a flat upper border confer?

Answer 14

that there is a pleural effusion and a pneumothorax

Question 15

what can stimulate a raised hemidiaphragm?

Answer 15

fluid below the lung ( a subpulmonary effusion)

Question 16

what may fluid in the fissures indicate?

Answer 16

an intrapulmonary mass

Question 17

what volume is needed for pleural effusion to be detected on examination

Answer 17

500ml

Question 18

what are the complications of Pleural effusion?

Answer 18

simple parapneumonic effusion and complicated parapneumonic effusion = differentiated with aspiration cytology, serology and things

subcutaneous emphysema

haemorrhage

vagus nerve irritation

Question 19

what happens in a complicated PPE?

Answer 19

the pleural space will become acidic meaning antibiotics will not work so a pus filled space forms

once in this situation it is not going to go away by itself

Question 20

what may happen to the complicated PPE?

Answer 20

get empyema

this can rapidly coagulate and organise to form a fibrous peel even with antibiotics

Question 21

what are the diagnostic features of an empyema ?

Answer 21

the pleural fluid will have a positive gram stain, pH

Question 22

how should it be treated?

Answer 22

treat underlying cause but drain if empyema (purulent fluid).

if symptomtic or empyema drainage

pleurdesis

surgery

Question 23

where are they commonly drained?

Answer 23

Thoracocentesis 5th intercostal space, mid-axillary line

Question 24

what is pleurodesis?

Answer 24

a method of sticking the chest wall and pleura together

Question 25

the fluid that accumulates may be either exudate or transudate

where are transudate normally seen

what is the protein content, lactic dehydrogenase, fluid to serum LDH ratio ?

Answer 25

can be bilateral but are often larger on the right side.

The protein content is

Question 26

what are some causes of transudate effusions?

Answer 26

heart failure

hypoproteinemia (nephrotic syndrome)

constrictive pericarditis

hypothyroidism

ovarian tumours producing
right sided pleural effusion

Question 27

what is the protein content, lactic dehydrogenase of exudate?

Answer 27

protein content is >30g/L

lactic dehydrogenase >200IU/L

Question 28

what are the causes?

Answer 28

Pneumonia, cancer (fluid may be blood stained) , TB, autoimmunity, MI, pancreatitis