PLEURAL EFFUSION

Question 1

WHAT IS PLEURAL EFFUSION?

Answer 1

• fluid in the pleural cavity between parietal and visceral pleura
• occurs as a result of imbalance in fluid production and removal due to local or systemic derangement

Question 2

WHAT ARE THE TWO CATEGORIES FOR EFFUSION?

Answer 2

1) Transudate- no protein/ due to systemic factors such as heart failure, cirrhosis, nephrotic syndrome
2) Exudate- protein present/ due to local factors such as leaky capillaries from inflammation secondary to infection, malignancy.

Question 3

WHAT ARE THE SYMPTOMS OF PLEURAL EFFUSION?

Answer 3

• dyspnoea
• pleuritic chest pain
• cough

Question 4

WHAT ARE THE SIGNS OF PLEURAL EFFUSION?

Answer 4

• auscultation - diminished breath sounds on affected side
• vocal resonance- reduced
• percussion - stony dull on affected side
• reduced chest expansion
• look for signs of associated disease- malignancy etc

Question 5

WHAT INVESTIGATIONS FOR PLEURAL EFFUSION?

Answer 5

1) CXR - blunt costophrenic angle, meniscus
2) Blood tests- FBC (underlying infection), CRP, LFT, U+E
3) US guided pleural aspiration - biochemistry (pH, protein, RBC)
4) pleural biopsy

Question 6

WHATIS THE MANAGEMENT OF PLEURAL EFFUSION?

Answer 6

• treat underlying cause

- drainage - thoracentesis, pleural drain