Pleural Effusion

Question 1

What are the symptoms of pleural effusion?

Answer 1

Shortness of breath
Weight loss
Cough
Haemoptysis
Chest pain
Lethargy
Fever

Question 2

What findings might be seen on systemic examination when there is a pleural effusion?

Answer 2

Clubbing
Ascites
Lymphadenopathy

Question 3

What criteria is used to determine if a pleural effusion is transudate or exudate?

Answer 3

LIGHTs criteria

Question 4

What findings would suggest that a pleural effusion is an exudate?

Answer 4

Any one of:
Fluid protein:serum protein >0.5
Fluid LDH:serum LDH >0.6
Fluid LDH >2/3 maximum serum normal

Question 5

What conditions could cause a transudate pleural effusion?

Answer 5

Heart failure
Cirrhosis
Renal Failure
Hypothyroidism
Hypoalbuminaemia

Question 6

What conditions could cause an exudate pleural effusion?

Answer 6

Malignancy
Infection
Empyema
TB
Haemothorax
Autoimmune
Pulmonary embolism
Post CABG/MI
Drug induced
Pancreatitis
Chylothorax

Question 7

How much fluid is required to be able to see a pleural effusion of CXR?

Answer 7

> 300ml

Question 8

What is the appearance of a pleural effusion of CXR?

Answer 8

Uniformly white appearance
Blunting of costophrenic and caridophrenic angles
Miniscus at upper edge
Fluid line

Question 9

An undiagnosed pleural effusion should not be drained. T/F?

Answer 9

True

Question 10

What is thoracoscopy?

Answer 10

Direct visual examination fo the pleura with a thorascope

Question 11

When would a thoracoscopy be used in the investigation of pleural effusion?

Answer 11

Undiagnosed cytology negative pleural effusions

Question 12

What is the name of the primary pleural malignancy?

Answer 12

Mesothelioma

Question 13

There can be metastatic spread of a tumour from which organs to the lung pleura?

Answer 13

Lung, Breast, ovaries, bowel, kidneys, lymphoma

Question 14

How is a malignant pleural effusion managed?

Answer 14

Chest drain +/- talc pleurodesis and indwelling pleural catheters

Question 15

Pleural effusion is common with pneumonia. T/F?

Answer 15

True

Question 16

What biochemistry results are seen with a complex parapneumonia effusion?

Answer 16

pH <7.2
LDH > 1000
Glucose <2.2

Question 17

What is empyema?

Answer 17

The presence of pus or bacteria in the pleura space

Question 18

How is empyema managed?

Answer 18

Drainage 12-16F
IV antibiotics
Fibrinolytics
Surgery
Ongoing clinical trials

Question 19

Larger drains are more useful in empyema. t/f?

Answer 19

False - These are more painful and are no more effective