Pleural Effusion

Question 1

What is a pleural effusion?

Answer 1

The build-up of excess fluid between the layers of the pleura outside the lungs.

Question 2

What are the types of pleural effusion?

How are they defined?

Answer 2

Transudative or Exudative

Transudate (<30g/L protein)
Exudate (>30g/L protein)

Question 3

What are the causes of transudative pleural effusion?

Answer 3

Heart failure (most common)
Hypoalbuminaemia (liver disease, nephrotic syndrome, malabsorption)
Hypothyroidism
Meigs’ syndrome

Question 4

What are the causes of exudative pleural effusion?

Answer 4

Infection: pneumonia (most common, TB, subphrenic abscess
Connective tissue disease: RA, SLE
Neoplasia: lung cancer, mesothelioma, metastases
Pancreatitis
Pulmonary embolism
Dressler's syndrome
Yellow nail syndrome
Oesophageal perforation

Question 5

What are the symptoms of pleural effusion?

Answer 5

Dyspnoea
Non-productive cough
Chest pain

Question 6

What are the signs of pleural effusion?

Answer 6

Dullness to percussion
Reduced breath sounds
Reduced chest expansion

Question 7

What are the investigations for pleural effusion?

Answer 7

Imaging:
PA chest x-rays
Ultrasound - can guide aspiration
Contrast CT

Pleural aspiration
(pH, protein, lactate dehydrogenase, cytology and microbiology)

Question 8

What criteria can be used to help distinguish between transudative and exudative PE in borderline cases?

Answer 8

Light’s criteria

Question 9

What should be done if patients with a PE have associated sepsis or a pneumonic illness?

Answer 9

Require diagnostic fluid sampling.

If the fluid is purulet/cloudy a chest tube should be placed to allow drainage.
Or if pH <7.2

Question 10

What is the management of recurrent pleural effusion?

Answer 10

Recurrent aspiration
Pleurodesis
Indwelling pleural catheter
Drug management to alleviate symptoms