Pleural Effusion Flashcards
What is a pleural effusion?
Fluid that builds up in the pleural space
What investigations do you order for a pleural effusion?
- CXR
- Thoracentesis
What will be covered in the fluid sampling?
- Cell count
- Cytology
- Amylase
- pH
- Glucose
- Adenosine deaminase
- LDH
- Total protein
- Cholesterol
What is an exudate fluid?
High protein count (>30g/L)
What is a transudate fluid?
Low protein count (<30g/L)
What causes an exudate pleural effusion?
- Lung cancer
- Pneumonia
- Rheumatoid arthritis
- TB
- Pulmonary infarction
- SLE
- Acute pancreatitis
- Malignancy
- PE
What causes a transudate pleural effusion?
Imbalances in hydrostatic and oncotic pressure causing movement of fluid from peritoneal or retroperitoneal spaces into pleural spaces
- CHF
- Hypoalbuminemia
- Hypothyroidism
- Nephrotic syndrome
- Liver cirrhosis
- Meig’s syndrome
What is Meig’s syndrome?
Triad of:
- Right-sided pleural effusion,
- Ovarian cancer
- Ascites
What does a bloody appearance indicate?
- Malignancy
- Asbestosis
- Pulmonary Infarction
- Postcardiac Injury Syndrome
What does a white (milky) appearance indicate?
- Chylothorax
- Cholesterol Effusion (pseudochylothorax)
What does a black appearance indicate?
Aspergillus
What does a yellow-green appearance indicate?
Rheumatoid Pleurisy
What does a dark green appearance indicate?
Bilothorax
What does pus indicate?
Empyema
What is Light’s Criteria?
If at least one of the following is met, then it is exudate:
- Pleural fluid protein: serum protein >0.5
- Pleural fluid LDH: serum LDH >0.6
- Pleural fluid LDH> 2/3 the upper limits of normal serum LDH
How does cell count indicate whether the effusion is transudate or exudate?
Transudates <1,000 cells/uL
Exudates >50,000 cells/uL
What does lymphocytosis indicate?
- TB
- Sarcidosis
- Malignancy
What do high neutrophils indicate?
- Empyema
- PE
What is a high serum amylase?
- Pleural fluid amylase > the upper limit of normal for serum amylase
OR - Pleural fluid amylase: serum amylase >1
What does a high amylase indicate?
- Acute pancreatitis
- Chronic pancreatic pleural effusion
- Oesophageal rupture
- Malignancy
What does a low pH indicate?
Increased acid production by pleural fluid cells
- Empyema
Decreased hydrogen iron efflux
- Malignancy
- Rheumatoid pleurisy
- TB pleurisy
What does a glucose <3.4 mmol/L indicate?
- Empyema
- Rheumatoid effusion
- TB
- Malignancy
- Oesophageal rupture
What does a glucose <1.6 mmol/L indicate?
- Empyema
- Rheumatoid disease
What does an adenosine deaminase >50 indicate?
TB
