Pleural effusion Flashcards
what is a pleural effusion
abnormal collection of fluid in pleural space
what type of effusions should raise concern
large unilateral ones
does a pleural effusion cause mediastinal shift
not really
what is transudate
fluid pushed through the capillary due to high pressure within the capillary
what is exudate
fluid that leaks around the cells of the capillaries caused by inflammation
what tests should be carries out to diagnose a pleural effusion
history + exam, PA CXR, aspirate, bio chem (trans/exudate), cytology, culture
where does pleural effusion always collect?
at the base of the lungs
when can pleural effusions look like masses on CXR
when fluid collects between horizontal fissures
what conditions cause a pleural effusion to have a straw-coloured appearance
cardiac failure, hypoalbuminaemia
what conditions cause a pleural effusion to have a bloody appearance
trauma, malignancy, infection, infarction
what conditions cause a pleural effusion to have a milky/turbid appearance
empyema, chylothorax
what conditions cause a pleural effusion to be foul smelling
anaerobic empyema
what causes a pleural effusion to contain food particles
oesophageal rupture
what conditions cause a bi lateral pleural effusion
LVF, PTE (pleural thromboendarterectomy), drugs, systemic path, heart failure
what conditions cause transudates
heart failure, liver cirrhosis, hypoalbuminaemia, atelectasis, peritoneal dialysis
what conditions cause exudates
malignancy, infection (inc TB), pulmonary infarct, asbestos
what is a normal pH for fluid in a pleural effusion
around 7.6
what does a pH less than 7.3 suggest
pleural inflammation (malignancy)
what does a Ph less than 7.2 require
drainage in the setting of infection
when is glucose in the fluid of a pleural effusion low
in infection, TB, rheumatoid arthritis, malignancy, oesophageal rupture, SLE (systemic lupus erythematosus)
what are you looking for in in cytology of a pleural effusion
malignant cells, lymphocytes (TB), neutrophils (acute process (inflammation/infection)
what microbiology tests can be used to analyse a pleural effusion sample
gram stain microscopy, culture, PCR, AFB stain, liquid culture
what does C4 mean
suspicion of malignancy
what is a thoracentesis
pleural tap
what types of cancer can present as a pleural effusion
any
what types of tissue biopsy are there for pleural effusions
blind percutaneous, CT guided cutting needle, thoracoscopy, thoracotomy (incision into pleural space
why are biopsies often negative
bad technique, effusion ancillary to malignancy but not malignant
what are the systemic effects of tumours that have ancillary effusions
embolism, hypoalbuminaemia
what is hypoalbuminaemia
low levels of albumin in blood
what are the local effects of tumours with ancillary effusions
postobstructive infection, lymphatic obstruction, atelectasis
what is mesothelioma
tumour of the ling of the lung or (very occasionally) lining of the abdominal cavity
what treatment options are available for malignant pleural effusions
palliate symptoms, repeated pleural taps, drain and/or pleurodesis, long term pleural catheters, surgical options (abrasion, pleurectomy
what is a pleurodesis and when is it (+/- drain) completed
pleural space obliterated, talc slurry (talc + lidocaine) or during thoracoscopy
what is talc
sclerosing agent
what is talc slurry
talc in suspension with lidocaine
what is the most common complication of Talc
minor pleuritic pain and fever
what is the purpose of long term pleural catheters
allow patients to control effusion and symptoms
what are the complications of long term pleural catheters
incorrect placement, bleeding, infection
what does a lent score predict
survival in malignant pulmonary effusion
in what group of people is a pneumothorax more common
tall thin men, smokers, cannabis, underlying lung disease
whats the difference between primary and secondary pneumothorax
secondary had underlying lung disease (e.g COPD)
