Pleural Effusion

Question 1

What is pleural effusion?

Answer 1

Fluid in the pleural space

Question 2

How does it present?

Answer 2

• Pleuritic chest pain

- Dyspnoea

Question 3

What examination findings are there on percussion?

Answer 3

• Stony dull percussion

Question 4

What examination findings are there on auscultation?

Answer 4

Reduced breath sounds

Question 5

What examination findings are there on observation/palpation?

Answer 5

• Trachea may deviate away

- Reduced chest expansion

Question 6

What will you see on CXR?

Answer 6

• Meniscus
• Blunting of costophrenic angles
• Fluid in the lung fissures

Question 7

What special test should you use?

Answer 7

Diagnostic aspiration (USS guided)

• Visual inspection
• Protein level

Question 8

What protein content signifies exudate in a tap?

Answer 8

35g/L

Question 9

What cause is identified by an exudate?

Answer 9

Infection

Question 10

What does each of these colours mean on inspection of the pleural fluid?

• Clear
• Yellow/turbid
• Red

Answer 10

• Clear = normal
• Yellow/turbid = Empyema
• Red = Haemothorax

Question 11

What can cause a haemothorax?

Answer 11

• Cancer

- Infection

Question 12

Name a criteria for exudates.

Answer 12

Light’s Criteria for Exudates

Question 13

Name three parameters/values of Light’s Criteria for Exudates.

Answer 13

• Effusion protein/Plasma protein= 0.5+
• Effusion LDH (lactate dehydrogenase)/Plasma LDH= 0.6+
• Effusion LDH= greater than 2/3 of the upper limit

Question 14

What could neutrophils in the effusion fluid mean?

Answer 14

• Bacterial infection
• PE
• Parapneumonic effusion e.g. abscess

Question 15

What could lymphocytes in the effusion fluid mean?

Answer 15

• Rheumatoid

- Viral

Question 16

How would you treat a pleural effusion?

Answer 16

• Treat underlying cause e.g. Abx
• Drain if large effusion- small effusions self-resolve
• Pleurodesis- use something like talc to bind lung to chest wall (destroying the pleural space)