Pleural effusion Flashcards
What are the four main causes of pleural effusion?
heart failure, malignancy, parapneumonic, PE
What investigations should be ordered for pleural fluid?
protein, LDH, pH, glucose, MCS, AFB, cytology
According to Light’s criteria, when is an effusion exudative?
if any of the following 3 are present:
- pleural protein/serum protein > 0.5
- pleural LDH/serum LDH > 0.6
- pleural LDH > 2/3 upper limit normal of serum level
How many effusions are misclassified as exudates according to Light’s criteria?
up to 25%
What does a serum pleural protein gradient < 31g/L mean?
exudate
What does a serum pleural albumin gradient < 12g/L mean?
exudate
Does connective tissue disease cause an exudate or a transudate?
exudate
Name 3 drugs which cause an exudative pleural effusion
nitrofurantoin
amiodarone
methotrexate
What are some common causes of a transudative pleural effusion?
heart failure cirrhosis nephrotic syndrome peritoneal dialysis hypoalbuminaemia
What biomarker can assist in diagnosis of heart failure associated pleural effusion?
NT pro BNP
If a neutrophilic pleural fluid has a CRP > 45 what is the most likely cause?
para pneumonic
What biomarker can assist in diagnosis of tuberculosis associated pleural effusion?
adenosine deaminase
How often in pleural fluid cytology positive in malignancy?
20-60%
With what type of malignancy is cytology more likely to be positive?
adenocarcinoma
What is the likely diagnosis if pleural fluid glucose is more than double the serum glucose?
peritoneal dialysis
What is the likely diagnosis if pleural creatinine is more than double serum creatinine?
urinothorax
What is the likely diagnosis if there is a raised beta2 transferrin in the pleural fluid?
duropleural shunt
When might a pleural effusion that is caused by renal failure be exudative?
if patient is on long term haemodialysis or is uraemic
Which patients with a pleural infection should have chest tube drainage?
if pleural fluid is purulent, gram stain/culture positive or pH < 7.2
When should you consider using intrapleural t-PA or DNase in pleural infection?
if not responding to IV abx and chest tube drainage and VATS is not available quickly
What did the MIST 2 trial show?
intrapleural t-PA-DNase therapy improved fluid drainage in patients with pleural infection and reduced frequency or surgical referral
