Pleural Effusion

Question 1

What is pleural effusion?

Answer 1

An abnormal collection of fluid in pleural space.

Question 2

What should raise concern?

Answer 2

Large unilateral effusion

Question 3

Pleural Fluid appearance

Answer 3

• Straw Coloured => Cardiac failure.
• Bloody => trauma, malignancy, infection.
• Turbid/Milky => empyema, chylothorax.
• Foul smelling => anaerobic empyema.
• Food Particles => oesophageal rupture.

Question 4

Biochemistry

Answer 4

Transudates & exudates

Question 5

Transudates: Protein

Answer 5

• Protein < 30g/L

Question 6

Exudates: Protein

Answer 6

• Protein > 30g/L

Question 7

Transudates: Conditions

Answer 7

Heart failure, liver cirrhosis, hypoalbuminaemia, atelectasis, peritoneal dialysis.

Question 8

Exudates: Condition

Answer 8

Local disease, malignancy, infection, pulmonary infarction, asbestos.

Question 9

Fluid pH

Answer 9

• 7.6 => Normal.
• < 7.3 => Pleural Inflammation.
• < 7.2 => Requires Drainage.

Question 10

Glucose

Answer 10

Low in infection, rheumatoid Arthiritis, malignancy, oesophageal rupture & SLE.

Question 11

Diagnosis:

Answer 11

Biochemistry tests (fluid pH & glucose), pleural aspirate, repeat pleural tap, PACXR, CT Chest, Culture, Tissue Biopsy.

Question 12

Pleural Aspirate

Answer 12

Will diagnose malignancy in 60% => 2nd sample will increase yield.