Pleural Effusion Flashcards
What are the two types of pleural effusions?
What are some examples which may cause each?
Transudative: Decrease in osmotic pressure
Cirrhosis
CHF
Nephrotic Syndrome
Exudative: Increased inflammation and increased capillary permeability Malignancy PE Infection (Bacterial Pneumonia or TB) Chylothorax
There is a BILATERAL pleural effusion visible on CXR; this suggests which clinical conditions?
CHF
Renal Failure
Fluid overload
(TRANSUDATIVE – BILATERAL) TRAN’nies are BOTH genders
There is a UNILATERAL pleural effusion present on CXR. What would remain at the top of your differential after observing this finding?
Malignancy Trauma Infection Chylothrorax (EXUDATIVE -- UNILATERAL)
T/F
Transudative effusions rarely require further interventions.
True
No extensive intervention usually necessary
May require drainage (thoracentesis) however if too much fluid build up
Fluid is drained during a thoracentesis of suspected pleural effusion. It is clear in color which leads you to suspect it is which type?
Transudative (effusion is clear in color once drained)
Exudative would have been yellowish-brown more infectious in nature
What is Light’s Criteria utilized for?
What are the criteria?
Determining Exudate v. Transudate
EXUDATE IF 1 of the following!
- Pleural fluid protein / serum protein > 0.5
- Pleural fluid LDH / serum LDH > 0.6
- Pleural fluid LDH > 2/3 of the normal upper limit for LDH
Since increased inflammation (and/or infxn) is the hallmark cause of EXUDATIVE effusions…
Increased protein and LDH would make sense because inflammatory cytokines are protein in nature and the LDH enzymes would will follow for energy production at the site of inflam. modulation.
What UTI medication can cause a pleural effusion?
Nitrofurantoin
What is the clinical presentation of a pleural effusion?
SOB
Pleuritic Px w/ cough
Dyspnea on exertion
Orthopnea
DECREASED TACTILE FREMITUS
(decreased because the effusion is located in the pleural space and acts as a barrier between lung sounds and the exterior body)
Dullness to percussion Egophony Decreased breath sounds Friction Rub Mediastinal shift away form unilateral effusion
A CXR was ordered for a PT with a suspected pleural effusion. What findings could you expect on the CXR?
ONLY VISIBLE if >200mL
Blunted costophrenic angles
Mediastinal shift away from affected side (only in unilateral (Exudative) effusions)
A thoracostomy tube is about to be placed or a thoracentesis is about to be performed; what imaging study should you order to ensure its proper insertion into the effusion?
Ultrasound
When would a CT scan for a pleural effusion be indicated?
Small effusions; that are complicated paraneumonic or possible empyema
After fluid is drawn from a pleural effusion during a thoracentesis; what labs would you want ordered on the fluid?
CBC w/ diff Protein and LDH BNP (to r/o cardiac CHF in origin) Gram and Acid Fast Bacillus Culture and sensitivity for bacteriology, cytology, and virology
(if malignancy suspected send 3 different samples to ensure malig. is not missed!)
The fluid pulled from an effusion appears milky in color; what might this be associated with?
Infectious discharge/pus –> CHYLOTHORAX
Triglycerides in lipid panel will be through roof (>110mg/dL) “obstructed thoracic duct”
Frank bloody fluid is pulled from an effusion; what remains at the top of your differential?
Malignancy (order glucose; b/c will be low because cancerous cells are using it at such a high rate to proliferate)
Pulmonary Emboli w/ associated INFARCT
Trauma
Post cardiac injury syndrome
Purulent fluid in removed pleural fluid would indicate an…
EMPYEMA
pH <7, glucose, cultures should be ordered
