Pleural Effusion Flashcards
How can you classify pleural effusion?
Transudative: protein <30g/L
Exudative: protein >30g/L
which it is helps determine cause
What causes Transudate pleural effusion? (4)
Transudate relates to fluid moving into pleural space
causes:
- Congestive cardiac failure
- hypoalbuminaemia
- hypothyroidism
- Meig’s syndrome (TRIAD - right sided pleural effusion, ovarian malignancy, ascites)
What causes exudative pleural effusion?
inflammation which causes protein to leak out into the pleural space
- Cancer - lung, mesothelioma, mets
- TB
- Pneumonia (most common)
- Rheumatoid arthritis/SLE
- PE
- Pancreatitis
- oesophageal perforation
How do pleural effusions present?
symptoms
- dyspnoea
- non productive cough
- chest pain
signs:
- dullness to percussion
- reduced breath sounds
- tracheal deviation away from effusion if massive
What investigations should you do for pleural effusions? 5
- PA CXR
- US
- CT - to look for underlying cause, esp exudative
- aspiration (US needed to reduce complication)
- pleural biopsy (if aspiration inconclusive)
What do you expect to see on CXR in pleural effusion?
- blunting of the costophrenic angel
- fluid in the fissures
- larger effusions will have a meniscus
- tracheal and mediastinal deviation
What do you test the pleural effusion aspirate for?
- protein count
- pH
- glucose
- LDH (lactate dehydrogenase)
- cytology
- microbiology testing
What is Lights criteria?
- distinguishes between exudative and transudative for borderline cases - 25-35g/L
important one to remember:
pleural fluid protein/serum protein = >0.5
How do you manage a pleural effusion?
- conservative management
- aspiration (may recur)
- chest drain (prevent reoccurrence)
What is an empyema
when should you suspect it
How is it treated?
infected pleural effusion
suspect in patients with improving pneumonia but new or ongoing fever
Tx - drainage, Abx
All patients with pleural effusion associated with sepsis or pneumonic illness should have pleural fluid sampling.
what are indications for drainage?
- fluid purulent or turbid/cloudy
- acidic pH (<7.2)
- low glucose/ high LDH
what is the management for repeated pleural effusions?
- aspiration
- pleurodesis
- indwelling pleural catheter
- drugs to relieve symptoms e.g opioids for dyspnoea
