Pleural Effusion

Question 1

What is pleural effusion?

Answer 1

The accumulation of serous fluid within the pleural space

Question 2

What is empyema?

Answer 2

accumulation of frank pus

Question 3

What are the two types of pleural effusion?

Answer 3

Transudative - as a result of either increased hydrostatic pressure or decreased osmotic pressure

Exudative - increased microvascular pressure due to disease of the pleura or injury in the adjacent lung

Question 4

What are common causes of it?

Answer 4

Pneumonia, TB, Pulmonary infarction, malignancy, cardiac failure, subdiaphragmatic disorders

Question 5

What are signs of pleural effusion?

Answer 5

Pleuritic pain, coughing, signs of pleural rub, breathlessness, reduced breath sounds, stony dull on percussion, reduced chest expansion

Question 6

How is pleural effusion investigated for?

Answer 6

CXR

Aspiration and biopsy

Question 7

What does CXR show?

Answer 7

curved shadow at lung case, blunting the costophrenic angle and curving towards axilla

Question 8

What does blood-stained effusion fluid suggest?

Answer 8

Malignancy

Pulmonary infarction

Question 9

What is the fluid like in cardiac failure?

Answer 9

serous, straw-coloured, transudate

Question 10

How is TB detected using the fluid?

Answer 10

Serous, amber fluid, exudative, lymphocytes predominant cell

Question 11

What does low pH fluid suggest?

Answer 11

Infection

Question 12

How is it managed?

Answer 12

treat underlying cause

Therapeutic aspiration may be required,

Question 13

What is the fluid like in empyema?

Answer 13

If the fluid is thick and turbid pus, empyema is confirmed. Other features suggesting empyema are a fluid glucose of less than 3.3 mmol/L (60 mg/dL), lactate dehydrogenase (LDH) of more than 1000 U/L, or a fluid pH of less than 7.0 (H+ over 100 nmol/L).

Question 14

What are Light’s criteria?

Answer 14

Exudate likely if one is met:

• pleural fluid protein:serum protein >0.5
• pleural fluid LDH:Serum LDH >0.6
• pleural fluid LD > 2/3 upper limit of normal of serum LDH

Question 15

What can pleural aspirate be investigated for?

Answer 15

Appearance - blood, colour, chyle. Culture, cytology (clusters of malignant cells staining as in the previous breast carcinoma), biochemistry (pH if suspected infection), protein, LDH, glucose

Question 16

What most appropriate next course of action after CXR?

Answer 16

Diagnostic Aspiration

Question 17

What is used for Diagnostic aspiration?

Answer 17

21G needle and 50ml syringe should be used