Pleural Effusion Flashcards
What are the symptoms of pleural effusion?
Shortness of breath Weight loss Cough Haemoptysis Chest pain Lethargy Fever
What findings might be seen on systemic examination when there is a pleural effusion?
Clubbing
Ascites
Lymphadenopathy
What criteria is used to determine if a pleural effusion is transudate or exudate?
LIGHTs criteria
What findings would suggest that a pleural effusion is an exudate?
Any one of:
Fluid protein:serum protein >0.5
Fluid LDH:serum LDH >0.6
Fluid LDH >2/3 maximum serum normal
What conditions could cause a transudate pleural effusion?
Heart failure Cirrhosis Renal Failure Hypothyroidism Hypoalbuminaemia
What conditions could cause an exudate pleural effusion?
Malignancy Infection Empyema TB Haemothorax Autoimmune Pulmonary embolism Post CABG/MI Drug induced Pancreatitis Chylothorax
How much fluid is required to be able to see a pleural effusion of CXR?
> 300ml
What is the appearance of a pleural effusion of CXR?
Uniformly white appearance
Blunting of costophrenic and caridophrenic angles
Miniscus at upper edge
Fluid line
An undiagnosed pleural effusion should not be drained. T/F?
True
What is thoracoscopy?
Direct visual examination fo the pleura with a thorascope
When would a thoracoscopy be used in the investigation of pleural effusion?
Undiagnosed cytology negative pleural effusions
What is the name of the primary pleural malignancy?
Mesothelioma
There can be metastatic spread of a tumour from which organs to the lung pleura?
Lung, Breast, ovaries, bowel, kidneys, lymphoma
How is a malignant pleural effusion managed?
Chest drain +/- talc pleurodesis and indwelling pleural catheters
Pleural effusion is common with pneumonia. T/F?
True
What biochemistry results are seen with a complex parapneumonia effusion?
pH <7.2
LDH > 1000
Glucose <2.2
What is empyema?
The presence of pus or bacteria in the pleura space
How is empyema managed?
Drainage 12-16F IV antibiotics Fibrinolytics Surgery Ongoing clinical trials
Larger drains are more useful in empyema. t/f?
False - These are more painful and are no more effective
