Pleural effusion

Question 1

What is a pleural effusion?

Answer 1

Accumulation of fluid in the pleural space

Question 2

What are Sx of pleural effusion?

Answer 2

May be none or SOB, pleuritic chest pain, dry cough, chest heaviness and referred pain

Reduced chest expansion, reduced tactile/vocal fremitus, stony dull percussion note

Quiet breath sounds

Question 3

What are causes of pleural effusions?

Answer 3

Transudates: CCF, low albumin, cirrhosis, HF, nephrotic syndrome

Exudates: pneumonia, cancer, TB

Question 4

What is difference between transudate and exudate?

Answer 4

Transudate: usually bilateral, low protein and low LDH

Exudate: usually unilateral, high protein and LDH

Question 5

What is light’s criteria

Answer 5

For exudate, protein must be: LDH >2/3 upper limit normal of serum LDH, pleural LDH/serum LDH ratio >0.6, pleural/serum protein ratio >0.5

Question 6

What Ix in pleural effusion?

Answer 6

Pleural fluid sampling and analysis: LDH, protein, glucose, microbio, RBC, WBC, cytology…
CXR
US

Thoracoscopy (medical or VATS) if cause unknown
Pleural biopsy +/- chest drain

Question 7

What is Rx of effusion

Answer 7

Treat the cause

therapeutic thoracentesis (US guided)

pleurodesis done in cancer patients