Pleural effusion Flashcards
What is a pleural effusion?
Fluid in pleural space
Pleural effusions may be transudate or exudate.
How are these differentiated?
Transudate <25g/L
Exudate > 35g/L
What term describes blood in the pleural space?
Haemothorax
What word describes pus in the pleural space (or other cavities)?
Empyema
What word describe chyle (lymph with fat) in the Thora x ?
Chylothorax
What are causes of transudates?
Raised venous pressure
Hypoproteinaemia
Hypothyroidism
Meig’s syndrome (right sided heart failure+ ovarian fibroma)
What may cause raised venous pressure?
Heart failure
Fluid over load
Constrictive pericarditis
What may cause hypoproteinaemia?
Liver cirrhosis
Nephrotic syndrome
Malabsorption
What causes exudates?
Increased leakiness of pulmonary capillaries secondary to:
Infection,
Inflammation
Malignancy
Clinical symptoms of pleural effusion?
Dyspnoea and Pleuritic chest pain
Often as symptomatic tho
Signs of pleural effusion?
On side of effusion (decreased expansion, shifting dullness to percussion and diminished breathing sounds)
Bronchial breathing- above effusion where lung is compressed
Tracheal deviation – with large effusions
Diagnostic tests for pleural effusion?
CXR
Ultrasound
Diagnostic aspiration
What would CXR show in a pleural effusion?
Small effusions blunt to costo-phrenic angle
Larger effusions are seen as water dense shadows with concave upper boarders
Flat horizontal upper border indicates there’s also a pneumothorax
What would you do with a diagnostic aspirate?
Send it for:
Clinical chemistry
Cytology
Bacteriology
Treatment for pleural effusion?
Treat underlying cause
Aspirate for symptom relief if necessary
Pleurodesis with tetracycline, bleomycin for recurrent effusions
