Pleural Effusion Flashcards
What is a pleural effusion
A collection of fluid in the pleural space
What causes a pleural effusion
When the balance between fluid filtration by the parietal pleura and fluid absorption by the visceral pleura is no longer balanced, leading to a build up of fluid in the pleural space
What might a patient with pleural effusion complain of
Breathlessness - sometimes with pleuritic pain
Does pleural effusion cause clubbing
No
What would you expect to find on examination of a patient with a pleural effusion
Tachypnoea Deviated trachea - away from effusion Asymmetrical decreased chest expansion Reduced tactile vocal fremitus Stony dull to percussion Reduced breath sounds
- Bronchial breath sounds may be heard at the top of the effusion
- Any signs of failure/malignancy that may indicate a cause
What is aegophony
Bronchial breathing at the top of an effusion
What diagnostic investigations would be done for a patient with a suspected pleural effusion
CXR
Pleural tap
What would you test the pleural tap for in a pleural effusion
Protein Glucose LDH Cell count Culture and microscopy Cytology pH
What information does the protein level in a pleural tap give you
Whether the effusion is a transudate or an exudate
What is a transudate
An effusion with a protein content less than 30
What is an exudate
An effusion with a protein content >30
How would transudates and exudates appear on a pleural tap
Yellow, straw colour
What information does the glucose in a pleural tap give you
Low glucose points towards infection or connective tissue disease as the cause of the effusion
What information would you get from the cell count in a pleural tap
Neutrophils - predominant cells in acute inflammation or infection
Lymphocytes - predominant cells in chronic effusions, particularly caused by TB or malignancy
What might cytology show on a pleural tap
Malignant cells
