Pleural Effusion

Question 1

what is a pleural effusion

Answer 1

collection of fluid in the pleural cavity

Question 2

what is an exudative effusion

Answer 2

high protein content > 30g/L

Question 3

what things cause an exudative effusion

Answer 3

causes related to inflammation:

• pneumonia (most common)
• TB
• Lung cancer
• RA

Question 4

What is a transudative effusion

Answer 4

lower protein content < 30g/L

Question 5

what things cause a transudative effusion

Answer 5

causes related to fluid moving across the pleural space

• Heart failure
• Hypoalbuminaemia
• Hypothyroidism
• Meig’s syndrome

Question 6

signs + symptoms of a pleural effusion

Answer 6

SOB, cough, pleuritic chest pain 
dullness to percussion over effusion 
reduced breath sounds
decreased chest expansion
tracheal deviation away from effusion if massive

Question 7

1st line investigation of pleural effusion

Answer 7

CXR (PA view)

Question 8

signs of pleural effusion on CXR

Answer 8

Blunting of costaphrenic angle

fluid in the lung fissures

Question 9

what tests does the pleural fluid undergo

Answer 9

sample is aspirated and analysed for

• protein count (Lights criteria)
• cell count
• pH
• glucose
• LDH
• microbiology

Question 10

what is empyema

Answer 10

an infected pleural effusion

• aspiration shows pus
• acidic pH
• low glucose
• high LDH

Question 11

how is empyema managed

Answer 11

chest drain 5th intercostal space mid-axillary line

Question 12

management of a pleural effusion

Answer 12

diagnostic aspiration – transudate or exudate ?

treat underlying cause / chest drain to relieve symptoms