Pleural effusion Flashcards
What is pleural effusion?
Accumulation of fluid in the pleural cavity between the lining of the lungs and the thoracic cavity (i.e., the visceral and parietal pleurae)
What is the pathophysiology of transudate and exudative pleural effusion?
(Transudative) ↑ Capillary hydrostatic pressure (increased capillary wedge pressure) or ↓ Capillary oncotic pressure
(Exudative) ↑ Capillary permeability (e.g., due to inflammation)
What are some causes of transudate pleural effusion?
Congestive heart failure
Hepatic cirrhosis
Nephrotic syndrome
Protein-losing enteropa
What are some causes of exudate pleural effusion?
(Infection) Pneumonia (parapneumonic effusion), Tuberculosis
(Malignancies)
(Pulmonary embolism)
(Autoimmune disease) Vasculitis, SLE, Rheumatoid arthritis, Sarcoidosis
What are the symptoms of pleural effusion?
small pleural effusion (< 300 mL) are often asymptomatic
Dyspnea
Pleuritic chest pain
Dry, nonproductive cough
Symptoms of the underlying disease
(Palpation and auscultation) Reduced tactile fremitus + reduced breath sounds + dull percussion
How is pleural effusion diagnosed?
Posterioranterior (PA) chest x-rays
Ultrasound is recommended
CT contrast can identify underlying cause
(Pleural aspiration) and sent for pH, protein, lactate dehydrogenase (LDH), cytology and microbiology
How to distinguish between transudate and exudate pleural effusion?
(Light’s criteria) exudates have a protein level of >30 g/L, transudates have a protein level of <30 g/L
(Protein level is between 25-35 g/L) Light’s criteria should be applied, presence of any one indicates exudate)
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
What is the treatment for pleural effusion?
(Drainage)
(Pleurodesis) Using talc or thorascopic mechanical pleurodesis
(Treatment of underlying condition)
(Surgery)
