Pleural Effusion Flashcards
what is P effusion?
an excessive accumulation of fluid in the pleural space
what are the causes of transudate?
may be due to increased venous pressure
or hypoproteinaemia
It also occurs in hypothydroidism and Meigs syndrome
what can cause increase in venous pressure?
cardiac failure, constrictive pericarditis, fluid overload
what causes hypoproteinaemia?
cirrhosis, nephrotic syndrome, malabsorption
what are the causes of exudate?
most commonly due to increased leakiness of pleural capillaries secondary to infection, inflammation or malignancy
what are some examples of these causes of exudate ?
pneumonia; TB; pulmonary infarction; rheumatoid arthritis; SLE; bronchogenic carcinoma; malignant metastases; lymphoma; mesothelioma; lymphangitis carcinomatosis.
what are the symptoms?
worsening dyspnoea
cough
pleuritic pain
or may be asymptomatic
what are the signs ?
decreased expansion
stony dull percussion
diminished breath sounds on the affected side
tactile vocal fremitus and vocal resonance are decreased - not as reliable
what may be a sign of a large effusion ?
may be tracheal deviation away from the effusion
what should also be done on examination
look for signs of associated disease like clubbing cachexia and stuff
what investigations should be done?
CXR,
and examination - only detected when more than 500 ml is present
ultrasound may be done
diagnostic aspiration
pleural biopsy
what can be seen on CXR of a small effusion?
small effusions blunt the costophrenic angles
what can be seen on CXR of a larger effusion?
they are seen as water dense shadows with concave upper borders
what does a flat upper border confer?
that there is a pleural effusion and a pneumothorax
what can stimulate a raised hemidiaphragm?
fluid below the lung ( a subpulmonary effusion)
what may fluid in the fissures indicate?
an intrapulmonary mass
what volume is needed for pleural effusion to be detected on examination
500ml
what are the complications of Pleural effusion?
simple parapneumonic effusion and complicated parapneumonic effusion = differentiated with aspiration cytology, serology and things
subcutaneous emphysema
haemorrhage
vagus nerve irritation
what happens in a complicated PPE?
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
what may happen to the complicated PPE?
get empyema
this can rapidly coagulate and organise to form a fibrous peel even with antibiotics
what are the diagnostic features of an empyema ?
the pleural fluid will have a positive gram stain, pH
how should it be treated?
treat underlying cause but drain if empyema (purulent fluid).
if symptomtic or empyema drainage
pleurdesis
surgery
where are they commonly drained?
Thoracocentesis 5th intercostal space, mid-axillary line
what is pleurodesis?
a method of sticking the chest wall and pleura together
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 ?
can be bilateral but are often larger on the right side.
The protein content is
what are some causes of transudate effusions?
heart failure
hypoproteinemia (nephrotic syndrome)
constrictive pericarditis
hypothyroidism
ovarian tumours producing
right sided pleural effusion
what is the protein content, lactic dehydrogenase of exudate?
protein content is >30g/L
lactic dehydrogenase >200IU/L
what are the causes?
Pneumonia, cancer (fluid may be blood stained) , TB, autoimmunity, MI, pancreatitis
