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TCD 17 - Lung Cancer > Pleural Effusion > Flashcards

Pleural Effusion Flashcards

1
Q

What is a pleural effusion?

A

Fluid that builds up in the pleural space

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2
Q

What investigations do you order for a pleural effusion?

A
  • CXR

- Thoracentesis

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3
Q

What will be covered in the fluid sampling?

A
  • Cell count
  • Cytology
  • Amylase
  • pH
  • Glucose
  • Adenosine deaminase
  • LDH
  • Total protein
  • Cholesterol
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4
Q

What is an exudate fluid?

A

High protein count (>30g/L)

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5
Q

What is a transudate fluid?

A

Low protein count (<30g/L)

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6
Q

What causes an exudate pleural effusion?

A
  • Lung cancer
  • Pneumonia
  • Rheumatoid arthritis
  • TB
  • Pulmonary infarction
  • SLE
  • Acute pancreatitis
  • Malignancy
  • PE
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7
Q

What causes a transudate pleural effusion?

A

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
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8
Q

What is Meig’s syndrome?

A

Triad of:

  • Right-sided pleural effusion,
  • Ovarian cancer
  • Ascites
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9
Q

What does a bloody appearance indicate?

A
  • Malignancy
  • Asbestosis
  • Pulmonary Infarction
  • Postcardiac Injury Syndrome
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10
Q

What does a white (milky) appearance indicate?

A
  • Chylothorax

- Cholesterol Effusion (pseudochylothorax)

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11
Q

What does a black appearance indicate?

A

Aspergillus

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12
Q

What does a yellow-green appearance indicate?

A

Rheumatoid Pleurisy

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13
Q

What does a dark green appearance indicate?

A

Bilothorax

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14
Q

What does pus indicate?

A

Empyema

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15
Q

What is Light’s Criteria?

A

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
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16
Q

How does cell count indicate whether the effusion is transudate or exudate?

A

Transudates <1,000 cells/uL

Exudates >50,000 cells/uL

17
Q

What does lymphocytosis indicate?

A
  • TB
  • Sarcidosis
  • Malignancy
18
Q

What do high neutrophils indicate?

A
  • Empyema

- PE

19
Q

What is a high serum amylase?

A
  • Pleural fluid amylase > the upper limit of normal for serum amylase
    OR
  • Pleural fluid amylase: serum amylase >1
20
Q

What does a high amylase indicate?

A
  • Acute pancreatitis
  • Chronic pancreatic pleural effusion
  • Oesophageal rupture
  • Malignancy
21
Q

What does a low pH indicate?

A

Increased acid production by pleural fluid cells
- Empyema

Decreased hydrogen iron efflux

  • Malignancy
  • Rheumatoid pleurisy
  • TB pleurisy
22
Q

What does a glucose <3.4 mmol/L indicate?

A
  • Empyema
  • Rheumatoid effusion
  • TB
  • Malignancy
  • Oesophageal rupture
23
Q

What does a glucose <1.6 mmol/L indicate?

A
  • Empyema

- Rheumatoid disease

24
Q

What does an adenosine deaminase >50 indicate?

A

TB

25
Q

What does an LDH >1,000 indicate?

A
  • Empyema
  • Rheumatoid pleurisy
  • Malignancy
26
Q

How do you treat large effusions?

A

o Pleural aspiration

o Chest drain

27
Q

What is a talc pleurodesis?

A

Drug is put into pleural space which causes irritation to the outer lining of the lung and chest wall.

This causes these surfaces to become sticky and bond together – sealing up the space between them and preventing fluid or air from collecting there.

28
Q

What are the indications for a talc pleurodesis?

A
  • Recurrent malignant pleural effusions

* Likely recurrent pleural effusions

29
Q

What are the characteristics of an empyema?

A
  • Pus
  • Low glucose
  • High LDH

TCD 17 - Lung Cancer (5 decks)

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