Pleural Effusion Flashcards
What is it?
Excess fluid in the pleural space
What is the difference between transudates and exudates?
Transudates - low protein conc.
Exudates - high protein conc.
Transudate is fluid pushed through the capillary due to high pressure within the capillary.
Exudate is fluid that leaks around the cells of the capillaries caused by inflammation. - that is why the protein conc is high as damaged vessels causes leakage of protein.
What is the following:
- Empyema
- Chylothorax
- Haemopneumothorax
Pus in the pleural space
Lymphatic fluid with fat ——
Blood and air —–
Transudative effusion:
(1) It is caused by raised venous pressure:
- What type of HF causes it?
- Why does constructive pericarditis cause it?
- Why does fluid overload cause it?
(2) It is also caused by hypoproteinaemia
- What organ is damaged could cause this?
- What is one obvious thing that would cause low protein?
- Nephrotic syndrome - what is it and why does it cause this?
How does hypothyroidism cause it?
Is it usually bilateral or unilateral?
Fluid overload - forces fluid out of the blood
LVF
Constrictive pericarditis - unable to refill the heart
Cirrhosis
Malabsorption
A kidney disorder that causes your body to pass too much protein in your urine - less able to draw water back into the blood.
It increases in capillary permeability leading to extravasation of plasma proteins into the extravascular compartment.
Bilateral - due to organ failure so it will affect both sides equally
Exudative effusion:
Is it usually bilateral or unilateral?
It is caused by the 4 Inf.
Infection - 2
Infiltration - 4
Infarction - 2
Inflammation - 2
Unilateral
Infection - Pneumonia, TB
Infiltration (cancer) - Lung, breast, lymphoma, mesothelioma
Infarction - PE, MI
Inflammation - RA, SLE
Symptoms:
It is usually asymptomatic.
What are the 3 main symptoms if present?
SOB
Cough
Pleuritic chest pain
Signs on examination:
- Expansion
- Percussion
- BS
- Vocal resonance
What type of breathing may be heard on auscultation?
What may be seen on examination if it is massive?
You may also look for signs of causes:
- What are some signs of lung cancer? - 3
- What are some signs of LHF?
Reduced vocal resonance
Reduced expansion
Stony DULL percussion
Reduced breath sounds
Bronchial breathing
A tracheal deviation - a mediastinal shift ==== Cachexia Clubbing Lymphadenopathy Radiation marks
Raised JVP
Investigations:
CXR - what is seen?
What other type of imaging may be used?
Opacification with fluid level - loss of costophrenic angle
Water dense shadows
USS
Pleural aspiration:
Indications - which type are they used for? Transudative or exudative
What is used to roughly distinguish between T and E?
What is the name of the criteria used to determine if the effusion is exudative?
EXUDATIVE - Transdudative is usually bilateral and is due to something my systemic.
The protein conc:
- T <30g/L
- E >30 - can remember (e)ggs - they are high in protein
Lights criteria
Pleural aspiration:
Lights criteria:
It is used to work out whether the pleural fluid is T or E if the protein conc is in the range of 25-30g/L.
What 2 ratios are used?
Pleural protein: serum protein
Pleural LDH : serum LDH
Pleural aspiration:
Gross appearance - what do the following suggest?
- Clear, straw-coloured
- Turbid, yellow
- Haemorrhagic
- White-coloured
What type of tests are done on the aspirate? - 3
Transudate/exudate
Empyema
Haemothorax
Trauma
Malignancy
Chylothorax == Cytology Clinical chemistry Immunology
What is the primary focus of management?
Treating underlying cause
Management - unilateral effusions only:
Drainage if symptomatic :
- Why is it done slowly (0.5-1.5L/24hrs)?
- What is needed to guide tap?
When are chest drains needed?
What is an indwelling pleural catheter or pleurodesis used for?
If it is to fast, it can cause re-expansion pulmonary oedema.
Needs to USS guided
If is it an empyema or signs of infection
If it is likely to recur - good for malignancy
