Pleural effusion Flashcards
What is a pleural effusion?
pleural effusion is fluid in the pleural space. Can be transudate ( low protein) or exudate (high protein)
What are the symptoms of pleural effusion?
- SOB
- Pleuritic chest pain
(or can be asymptomatic)
What are the signs of pleural effusion?
- decreased chest expansion
- stony dull percussion note
- diminished breath sounds
- reduced tactile vocal fremitus and vocal resonance
- bronchial breathing above effusion
- tracheal deviation (with large effusion)
Signs of malignancy:
- clubbing
- lymhadenopathy
- radiation marks
- mastectomy scar
signs of cardiac failure, liver disease, hypothyroid, rheumatoid arth, SLE butterfly rash
A risk factors / cause of transudate pleural effusion is increased venous pressure, what causes this?
1) Increased venous pressure due to
- heart failure
- constrictive pericarditis
- fluid overload
A risk factor / cause of transudate pleural effusion is hypoproteinaemia. What is the cause of this?
Hypoproteinemia:
- liver failure
- cirrhosis
- malabsoprtion
- nephrotic syndrome
What is Meig’s syndrome?
right pleural effusion
ovarian fibroma
What causes exudate pleural effusion?
Increased leakiness of pleural capillaries secondary to infection / inflamm / maliganancy e.g. pneumonia, TB, pulmonary infarction, Rheumatoid arthritis, SLE, lymphoma, lung Ca)
What invx are done for pleural effusion?
CXR:
- blunt costaphrenic angles in small effusions.
- water dense shadows with concave upper borders in larger effusions.
- completely flat upper border = pneumothorax + effusion.
USS (identify fluid and guide aspiration)
Diagnostic aspiration + send to lab for analysis (percuss upper border of effusion then go 1 or 2 intercost spaces below.
Pleural biospy (if pleural fluid annalysis inconclusive)
How is a pleural effusion managed?
1) Drainage
2) Pleurodesis (if recurrent)
3) surgery (last option if recurrent)
