Pleural Effusion

Question 1

What is a pleural effusion?

Answer 1

Collection of fluid in pleural cavity

Exudative or Transudative - Protein > 3g/dL (ex) or <3g/dL (trans)

Question 2

Exudative causes of pleural effsion

Answer 2

Related to inflammation
Protein leaks out of tissues into pleural space

Lung cancer
Pneumonia
Rheumatoid arthritis
Tuberculosis

Question 3

Transudative causes of pleural effusion

Answer 3

Congestive cardiac failure
Hypoalbuminaemia
Hypothroidism
Meig’s syndrome (right-sided pleural effusion with ovarian malignancy)

Question 4

Presentation of pleural effusion

Answer 4

SOB
Dullness to percussion over the effusion
Reduced breath sounds
Tracheal deviation AWAY from the effusion if it is massive

Question 5

Signs on CXR

Answer 5

Blunting of the costophrenic angle

Fluid in the lung fissures

Larger effusions will have a meniscus. Curving upwards where it meets the chest wall and mediastinum.

Tracheal and mediastinal deviation if it is a massive effusion

Question 6

What is sample of pleural fluid used for?

Answer 6

Protein count
Cell count
pH
Glucose
LDH
Microbiology testing

Question 7

Treatment for pleural effusion

Answer 7

Smaller effusions will resolve with treatment of underlying cause

Larger effusions require:

Aspiration: temporary relief but may reccur

Drainage

Question 8

When to suspect empyema

Answer 8

Patient who has an improving pneumonia but new or ongoing fever

Question 9

Pleural aspiration result for empyema

Answer 9

Pleural aspiration shows pus
Acidic pH (pH < 7.2)
Low glucose
High LDH

Treated with chest drain adn Abx