Pleural Effusion

Question 1

What is a pleural effusion?

Answer 1

Fluid in the pleural space

Question 2

What 3 classes of causes are there?

Answer 2

Pulmonary, Pleural or Extrapulmonary disease

Question 3

What is transudate?

Answer 3

Fluid containing <25g/L of protein

Question 4

What is exudate?

Answer 4

Fluid containing >25g/L of protein

Question 5

What causes transudates in the pleural cavity? (4)

Answer 5

Heart failure, cirrhosis, hypoalbuminaemia, peritoneal dialysis

Question 6

What causes exudates in the pleural cavity? (2)

Answer 6

Pneumonia, malignancy

Question 7

Is it common?

Answer 7

Malignant pleural effusion affects 40,000 people per year in the UK and benign pleural effusions are twice as common

Question 8

Symptoms (3)

Answer 8

*May be asymptomatic, dyspnoea, pleuritic chest pain

Question 9

Signs (7)

Answer 9

decreased chest expansion, stony dull percussion, diminished breath sounds, reduced tactile fremitus, reduced vocal resonance, bronchial breathing above the effusion, tracheal deviation

Question 10

Investigations (8)

Answer 10

Chest xray, Ultrasound, CT, MRI, Pleural fluid aspiration, pleural biopsy, thoracoscopy, bronchoscopy

Question 11

Treatment (6)

Answer 11

*Aim management at the underlying cause, diuretics, tapping of fluid, pleuridesis, pleurectomy, pleuro-peritoneal shunts

Question 12

Is there a good prognosis?

Answer 12

Depends on the cause of the effusion, presence of malignant effusion is a poor prognostic factor