Pleural Effusion

Question 1

Describe the secretion and drainage of pleural fluid

Answer 1

• Secreted by Parietal pleura

- Drained by lymphatics of Parietal pleura

Question 2

What is a pleural effusion?

What are 4 types?

Answer 2

Excess fluid in Pleural cavity

• Simple effusion: Pleural fluid in cavity
• Haemothorax: Blood in cavity
• Chylothorax: Chyle/ Lymph in cavity
• Empyema: Pus in cavity

Question 3

Compare the 2 types of Simple Effusion

Answer 3

Transudates;
- Low protein content (<30g/L)

Exudates;
- High protein content (>30g/L)

Question 4

How does Pleural Effusion present?

Answer 4

• Breathlessness
• Pleurisy
• Possible features of underlying disease (Pulmonary oedema, Congestive cardiac failure, Lung malignancy)

Question 5

How does a Pleural Effusion appear on examination?

Answer 5

• Trachea deviated away from affected side if large effusion
• Reduced chest movement
• ‘Stony’ Dull percussion
• Reduced/ absent breath sounds
• Reduced vocal resonance

Question 6

List the general causes of;

• Haemothorax
• Chylothorax
• Empyema

Answer 6

• Haemo: Trauma
• Chylo: Trauma
• Empyema: Infection

Question 7

List 2 types causes of Transudative Simple Pleural Effusion and give examples

Answer 7

Increased capillary hydrostatic pressure;
- Congestive cardiac failure

Decreased capillary oncotic pressure;

• Cirrhosis
• Nephrotic Syndrome

Question 8

Suggest 1 type of cause of Exudative Simple Pleural Effusion and give 5 examples

Answer 8

Increased capillary permeability

• Bronchial carcinoma
• Pneumonia
• TB
• Pulmonary infarction
• Metastases

Question 9

How can Pleural Effusion be treated?

Answer 9

• Treat underlying cause (Infection, Heart failure, Trauma etc)
• Chest aspiration if very symptomatic

In recurrent infections;

• Indwelling pleural catheter (IPC)
• Pleurodesis (Obliteration of pleural space)