Pleural effusion

Question 1

What is it

Answer 1

fluid collecting between parietal and visceral pleural surfaces of the thorax

Question 2

what are the causes>

Answer 2

1. Transudate:
   i. HF (increased hydrostatic pressure)
   ii. Hypoalbuminaemia (liver disease, nephrotic syndrome, malabsorption, less proteins in blood and more in pleural fluid, water moves into pleural space)
   iii. Cirrhosis (elevated portal pressure)
2. Exudative - capillary leaks:
   i. infection - pneumonia, TB
   ii. Ca - lung, mesothelioma
   iii. CTD - RA, SLE
   iv. pancreatitis

Question 3

What are the sx

Answer 3

SOB
Non-productive cough
Chest pain - pleuritic

Question 4

What can be found on examination?

Answer 4

Dullness to percussion
(hollow = resonant)
Reduced breath sounds over area of effusion
Decreased or absent tactile fremitus - sound waves do not travel when fluid is a barrier

Question 5

How is a pleural effusion diagnosed?

Answer 5

1. Imaging:
   - PA CXR - blunting of costophrenic angles
   - US
   - Contrast CT
2. Thoracentesis - pleural aspiration - pH, protein, LDH, cytology and microbiology

Question 6

How would u differentiate between the causes of pleural effusion?

Answer 6

Exudates - protein >30g/L
Transudates - <30g/L
Fluid appearance:
transudate - clear
exudate - cloudy

Question 7

What is the management of CCF induced PE?

Answer 7

Furosemide
Physio
Thoracentesis
O2

Question 8

What is the management of infection induced PE

Answer 8

IV abx - amoxicillin, metronidazole

Question 9

What is the management of all PEs?

Answer 9

thoracentesis (if big enough)
physio
oxygen

Question 10

What is the management of recurrent PE

Answer 10

recurrent aspiration
pleurodesis
indwelling pleural catheter
drugs to alleviate sx e.g. opioids to relieve SOB

Question 11

What is pleurodesis

Answer 11

gets two layers of lungs to stick to together so that fluid can’t build up

Question 12

How much pleural fluid is there normally?

Answer 12

a few mls