Pleural effusion

Question 1

Pleural effusion

Answer 1

excess fluid in the pleural space
1. Too much fluid produced
( maybe transudative or exudative)
2. Lymphatic do not drain the pleura cavity effectively

Question 2

Transudative Pleural effusion

Answer 2

1. Too much fluid begins to leave the capillaries due to
   - > Increased hydrostatic pressure
   - > Decreased oncotic pressure in blood vessels

Question 3

Transudative - increased hydrostatic pressures

Answer 3

Increased hydrostatic pressure
• Heart failure
- cant effectively pump blood to body
-Blood backs up into lungs and pulmonary vessels
- Pulmonary hypertension

-> Fluid forced out of capilaries and into pleural cavity

Question 4

Transudative Oncotic pressure

Answer 4

Cirrhosis and Nephrotic syndrome

• solutes unable to move across into capilary
• fluid moves out of the capillaries by osmosis into pleural cavity

Question 5

Exudative pleural effusion

Answer 5

Exudative pleural effusion
( Trauma, Malignancy, Lupus, Pneumonia/Infection)

• Inflammation of pulmonary capillaries
• Makes them a lot more leaky
• Larger spaces between endothelial cells allows more fluid to leak

Question 6

Lymphatic pleural effusion

(Chylothorax)

Answer 6

Tumors/Surgery
• Thoracic duct is distrupted
• Lymphatic fluid accumulates in pleural space

Question 7

Symptoms of pleural effusion

Answer 7

Depends on size

1. Pain on inhalation ( Pleurisy)
2. Shortness of breath
3. Worse lying flat
4. Decreased breaths sounds
5. Dullness to percussion
6. Decreased tactile fremitus- excess fluid absorbs voice vibrations
7. Tracheal deviation - if v large

Question 8

Diagnosis

Answer 8

• X - ray - blurring along costophrenic angle
• Thoracentesis - effusion
- Transudative fluid - clear
- Exudative fluid - full of immune cells ( more protein) and cloudy
- Lymphatic fluid - filled with fats and looks like milk