Pleural Effusion

Question 1

What is a pleural effusion

Answer 1

Fluid in pleural space

Question 2

Pleural effusion classifications

Answer 2

Transudate <25g/L
25-35g/L if pleural fluid protein/serum protein >0.5 then effusion is exudate
Exudate >35g/L

Question 3

Pleural effusion causes

Answer 3

Transudates due to:
Inc venous pressure
Hypoproteinaemia
Hypothyroidism

Exudates due to:
2˚ from infection/ inflammation
Pneumonia, TB
SLE

Question 4

Pleural effusion symptoms

Answer 4

Asymptomatic
Dyspnoea
Pleuritic chest pain

Question 5

Pleural effusion examination signs

Answer 5

Dec expansion, stony dull percussion + diminished breath sounds on affected side
Tracheal deviation away from large effusion

Question 6

Pleural effusion tests

Answer 6

CXR shows blunt costophrenic angles or water-dense shadows if large
US for presence of pleural fluid
Diagnostic aspiration
Pleural biopsy considered if rest inconclusive

Question 7

Pleural effusion diagnostic aspiration how to do

Answer 7

5-10ml lidocaine
21G needle 1 to 2 intercostal spaces below percussed border of fluid
Needle in just by upper border of rib to avoid NV bundle
Draw 10-30ml fluid and send for clinical chemistry, bacteriology, cytology and immunology if indicated

Question 8

Pleural effusion management

Answer 8

If symptomatic effusion, drain as necessary (0.5-1.5L/d)

Pleurodesis with talc for recurrent effusions

Thorascopic malignant pleurodesis for malignant effusions

Empyemas chest drain with US/CT guidance
Intra-pleural alteplase + dornase alfa may help with empyema

Surgery for persistent collections + inc pleural thickness on US