Pleural Effusion

Question 1

Clinical Features

Examination findings

Answer 1

Clinical Features:
- dyspnoea

• non-productive cough
• chest pain

Examination Findings:

• stony dullness to percussion
• reduced breath sounds
• reduced chest expansion

Question 2

Types

Answer 2

Transudative = protein <30 protein

Exudative = protein > 30

Question 3

Causes of transudative

Answer 3

Heart Failure

Liver failure (hypoalbuminaemia)

Kidney Failure (hypoalbuminaemia)

Meig’s Syndrome (ovarian fibroma associated with ascites and pleural effusions)

Question 4

Causes of exudative

Answer 4

Infection: pneumonia, tuberculosis

Malignancy: lung cancer

Connective Tissue Disease: SLE, rheumatoid arthritis (causes low glucose in effusion fluid)

Question 5

Lights criteria

Answer 5

Used to work out if effusion is transudative or exudative if protein is between 25 and 35

An exudate is likely if at least one of the following criteria are met:

• pleural fluid protein divided by serum protein >0.5
• pleural fluid LDH divided by serum LDH >0.6
• pleural fluid LDH more than two-thirds the upper limits of normal serum LDH

Question 6

investigations

Answer 6

Pleural Aspiration with ultrasound: send sample for pH, protein, microbiology, LDH

CT scan

CXR (PA)

Question 7

Management

Answer 7

If recurrent:

• chest drain
• pleurodesis
• investigate for cause