Pleural effusion

Question 1

How is the type of effusion classified?

Answer 1

Protein <30g/L = transudate

Protein >30g/L = exudate

Question 2

What is Light’s criteria?

And when is it used?

Answer 2

An exudate effusion has one off:

• Pleural fluid protein: serum protein ratio of >0.5
• Pleural fluid LDH: serum LDH ratio of >0.6
• Pleural fluid LDH is 0.6 x ULN

It’s used when effusion protein is between 25-35g/L

Question 3

What are the causes of an exudative effusion?

Which is the most common cause?

Answer 3

Increased capillary permeability

• Infection: TB, pneumonia
• Neoplasm: bronchial, lymphoma, mesothelioma
• Inflammation: RA, SLE
• PE
• Dressler’s syndrome
• Yellow nail syndrome

Most commonly - pneumonia

Question 4

What are the causes of a transudate effusion?

Answer 4

Increased capillary hydrostatic or decreased oncotic pressure

• CHF - increased venous pressure
• Renal failure
• Hypoalbuminaemia
• Hypothryoidism

Question 5

What is a pleural effusion?

Answer 5

Xs accumulation of fluid in the pleural cavity

Question 6

How does it present?

Answer 6

Can be ASX
Dyspnoea
Pleuritic chest pain
Non-productive cough

Question 7

Name 3 signs

Answer 7

Reduced lung expansion
Dull percussion
Reduced BS

Question 8

What IX do you need to request?

Answer 8

Bloods: FBC, U&E, LFT, TFT, Ca, ESR

Posterioranterior CXR
- IN ALL PT!

Dx Tap + USS (for aid)

Question 9

What do you see on CXR?

Answer 9

Blunt costophrenic angles

Dense shadows occupy hemithorax

Question 10

What do dx tap findings mean?

Answer 10

Low glucose: RA, TB

High amylase: pancreatitis, oesophageal perforation

Heavy blood staining: mesothelioma, PE, TB

Check for lactate and pH

Do MCS, TB culture

Question 11

How is it MX?

Answer 11

• RX underlying cause
• Recurrent aspiration/chest drain if needed
• Chemical pleurodesis if recurrent malignant effusion
  Indwelling pleural catheter
• Drug MX: opioids to relieve dyspnoea