Pleural effusion Flashcards
1
Q
Pleural effusion presentation
A
Asymptomatic early
SOB +/- Chest pain
Reduced breath sounds, stony dull percussion and reduced chest expansion over affected area.
2
Q
Types of Fluid in Plural space
A
Transudates- low protein fluid Exudates- high protein fluid Empyema- pus Haemothorax- blood Chylothorax-lymph
3
Q
Investigations
A
CXR: >330ml visible on plain film. Obliterated costophrenic angle
Plural Aspirate: gross appearance, pH, protein and lactic dehydrogenase, C&S, cytology
4
Q
Transudate vs Exudate
A
Transudate caused by low oncotic or high hydrostatic pressure.
Exudate cused by disruption of pleura itself causing increased production or decreased re-absorption of fluid.
Transudate < 30protein < Exudate
Transudate < 200 lactic dehydrogenase < Exudate
5
Q
Causes Transudate
A
Heart Failure Nephrotic Syndrome Pericarditis Hypothyroidism Some Ca (Meigs syndrome, ovarian) Liver Cihhrosis
6
Q
Causes Exudate
A
Pnuemonia Pulmonary Ca/ Mesothelioma TB Sarcoid Autoimmune Rheumatic disease (SLE, RA) Trauma PE Pancreatitis Post MI
7
Q
Management Plural Effusion
A
Hx, Exam, CXR If likely Transudate- treat cause If not resolved or likely Exudate refer Respiratory Aspiration under US guidance Cause identified - treat cause Not identified CT thorax +/- Biopsy Drain if symptomatic Antibiotics if Empyema If recurrent Drain to dry then Pleurodesis with talc/tetracycline Surgery/ permanent drain if progressive
