Pleural Effusion

Question 1

What are the common examination findings?

Answer 1

Inspection - Cachexic if malignancy

Hands - Clubbing if malignancy, may have signs of RA

Neck -lymphadenopathy if malignancy

Face - May have butterfly rash if SLE

Chest:

Trachea may be deviated if large

Chest expansion may be reduced

Air entry reduced

Percussion stony dull over bases

TVF reduced

Auscultation reduced or no breathe sounds

Question 2

What are the investigations?

Answer 2

By the bed - History, obs, peak flow, spirometry and sputum analysis including cytology, cardiovascular exam

Bloods - FBC for infection, AI immune screen (ANCA ANA and RF, Autoantibodies )and cultures

Other - CXR, Pleural analysis and biopsy, ABG, CT scan for staging

Question 3

What are the key investigation findings?

Answer 3

Depends on cause

CXR - Pleural effusion as loss of costophrenic angle

Protein over 30 or low PH = exudate

Protein under 40 or normal PH = transudate

Question 4

What is the treatment?

Answer 4

Conservative - Explain what it is and the need for MDT management - Physios, OT, GP, Consultant

Stop smoking

Medical - Radiotherapy and chemo if SCLC

Surgical - Resection if possible and NSCLC

Question 5

What are the causes

Answer 5

Water, Blood, Pus, tumour

Exudate - Malignancy or infection (TB, pneumonia) or inflammatory (RA, SLE)

Transudate - HF,Renal failure, Liver failure