Pleural Effusion

Question 1

What are the 2 types of effusion

Answer 1

Transudative (LHF, cirrhosis, nephrotic syndrome, myxedema)

Exudative (infection, malignancy, TB)

Question 2

WHat are the most common causes of effusion

Answer 2

HF>PNA>malignancy

Question 3

Physical exam findings

Answer 3

• Area of egophany just above effusion

- Once detected, confirm w/ chest rad, US, etc

Question 4

When should you do a thoracentesis?

Answer 4

In all effusions with > 1cm in decubitus view…but WHEN is the question…

If effusion is due to HF: diurese –> thoracentesis in 48 h

If effusion is due to infection: emergent thoracentesis

Question 5

What are Lights Criteria and what does meeting them mean?

Answer 5

1. High pleural fluid/serum protein ratio (>0.5)
2. Pleural LDH is >2.3 of ULN lab ratio
3. Pleural/serum ratio >0.6

If 1 of these are met…you have an exudative pleural effusion…therefore must do emergent thoracentesis after you draw culture and test for pH, glucose, WBCs w/ diff, and cytology.