Pleural Effusion

Question 1

Pleural Effusion

Answer 1

• Excessive Accumulation of Fluid in the Pleural
Space; Detected on CXR when >300mL present
due to the slopping nature of the Diaphragmatic
Pleura; Clinical when >500mL
• CXR – Loss of Costophrenic angle, Homogenous
shadow uni or bilaterally; Fluid in fissures may
resemble intrapulmonary mass
• Diagnosis is by Ultrasound-guided Pleural
Aspiration/Tap; Pleural Biopsy if diagnosis not
established by simple aspiration
• Treatment of underlying condition is sufficient;
Unless fluid is purulent (Empyema) where
drainage is indicated

Question 2

Transudative Effusion

Answer 2

• <30g/L protein, LDH <200IU/L,
Fluid:Serum LDH <0.6
• Heart Failure, Hypoproteinaemia (e.g.
Nephrotic Syndrome), Constrictive
Pericarditis, Hypothyroidism
• Ovarian Tumours (Meig’s Syndrome:
Right Sided Pleural Effusion)

Question 3

Exudative Effusion

Answer 3

• >30g/L protein, LDH >200IU/L
• Bacterial Pneumonia, Carcinoma (also
Blood-stained effusion), Tuberculosis,
Autoimmune Rheumatic Disease
• Dressler’s Syndrome (Post MI), Acute
Pancreatitis, Mesothelioma, Sarcoidosis

Question 4

Malignant Pleural Effusions

Answer 4

Reaccumulate and are symptomatic – Should be aspirated to
dryness followed by instillation of sclerosing agent (Tetracycline or Talc); Effusions should be
drained slowly as rapid Mediastinal shift causes severe pain and shock

Question 5

Chylothorax

Answer 5

Accumulation of Lymph in Pleural space usually following leakage from
Thoracic duct due to trauma or tumour infiltration