Pleural Effusion

Question 1

what are the protein g/L levels for transudate and exudate?

Answer 1

􏰀 Effusion protein < 25g/L = transudate
􏰀 Effusion protein >35g/L = exudate

Between 25-35g/L: apply Light’s Criteria

Question 2

state some causes of exudates

Answer 2

􏰀 Infection: pneumonia, TB
􏰀 Neoplasm: bronchial, lymphoma, mesothelioma
􏰀 Inflammation: RA, SLE
􏰀 Infarction

Question 3

state some cause of transudates?

Answer 3

􏰀 ↓ albumin: nephrosis, liver failure, enteropathy
􏰀 Hypothyroidism
􏰀 Meig’s Syndrome
Renal failure
CCF

Question 4

what is Meigs syndrome ?

Answer 4

􏰁 Right pleural effusion
􏰁 Ascites
􏰁 Ovarian fibroma

Question 5

what type of breathing is heard just above the effusion with pleural effusion ?

Answer 5

􏰁 Bronchial breathing just above effusion

Question 6

what blood tests should be done for pleural effusion?

Answer 6

FBC, U+E, LFT

TFT, Ca, ESR

Question 7

where is a diagnostic tap done?

Answer 7

1-2 spaces below the upper border

Question 8

what tests are done on the pleural aspiration?

Answer 8

􏰁 Chemistry: protein, LDH, pH, glucose, amylase
􏰁 Bacteriology: MCS, auramine stain, TB culture
􏰁 Cytology
􏰁 Immunology: SF, ANA, complement

Question 9

what will the protein, glucose, pH and LDH be for exudate effusion ?

Answer 9

􏰀 ↑ protein
􏰀 ↓ glucose <3.3mM
􏰀 ↓ pH <7.2
􏰀 ↑LDH>0.6xserum/ULN

Question 10

what investigation should be done if pleural tap is inconclusive ?

Answer 10

CT-guided ̄c Abrams needle for pleural biopsy

Question 11

what is the management of pleural effusions ?

Answer 11

􏰀 Rx underlying cause

􏰀 May use drainage if symptomatic (􏰂2L/24h)

􏰀 Chemical pleurodesis if recurrent malignant effusion

􏰀 Persistent effusions may require surgery