Pleural Effusion Flashcards
What are the findings in a respiratory exam in a person with a pleural effusion?
Tracheal Deviation
Decreased expansion
Stony Dull percussion note
Diminished breath sounds
What is the normal pH of the pleural fluid?
7.6
What is the pH of an infected effusion?
<7.2
In what conditions is the glucose levels in the pleural aspirate low?
Empyema Rheumatoid Lupus TB malignancy
Chest X-ray findings
Blunting of costophrenic angles with ‘white-out’
Meniscus- fluid level
Light’s Criteria
Pleural fluid with a protein concentration 25-35 g/L. Exudate If:
Fluid/serum protein of >0.5 OR
Fluid serum lactate dehydrogenase >0.6 OR
Fluid lactate dehydrogenase >2/3 the upper limit of normal serum
Causes of transudate effusions
Heart failure Hepatic failure Renal failure Hypothyroidism Pulmonary embolus Meig's syndrome
Causes of exudate effusions
Malignancy Infection Rheumatoid disease TB Empyema Sarcoidosis
What is an empyema?
Collection of pus within the pleural cavity
What causes an empyema?
Complication of thoracic surgery Rupture of lung abscess into the pleural space Perforation of oesophagus Mediastinitis Bacterial spread of pneumonia
Aspirate fluid in empyema
Yellow and turbid
<7.2
Low glucose
Increased LDH
Management of empyema
Chest drain inserted under radiological guidance
Antibiotic treatment
Management of the pleural effusion
If symptomatic- drain 0.5-1.5L/24hour
How to aspirate a pleural effusion?
Percuss the upper border of the pleural effusion and choose 1/2 intercostal spaces below it.
5-10 ml of 1% lidocaine
21G to a syringe and and insert above the upper border of an appropriate rib
Draw off 10-30ml of pleural fluid