Pleural Effusion Flashcards
1
Q
What is pleural effusion?
A
- Fluid accumulation in pleural cavity
2
Q
What are the two types of effusion?
A
- Exudate
- pleural protein >30g/L
- Transudate
- pleural protein <30g/L
3
Q
What causes exudate effusion?
A
- malignancy
- infection
- pneumonia, TB, HIV
- inflammation
- RA, benign asbestos effusion
4
Q
What causes transudate effusion?
A
- HF
- Cirrhosis
- Hypoalbuminamia
- Hypothyroidism
- PE
- Meig’s syndrome (R sided pleural effusion + ovarian malignancy)
5
Q
What are the sx of pleural effusion?
A
- Asymptomatic
- Dyspnoea
- Pleuritic chest pain
6
Q
What are the clinical signs of pleural effusion?
A
- Decrease expansion
- Stony dull precussion
- Reduced breath sounds
- Tracheal deviation (if massive effusion)
7
Q
What Ix would you order for Pleural effusion?
A
- Imaging
- CXR
- USS
- Special test
- Diagnostic aspiration
- Pleural biopsy
- thoracoscopic/CT guided pleural biopsy
8
Q
What are the CXR features of pleural effusion?
A
- blunting of costophrenic angle
- fluid in lung fissures
- If large/massive effusion
- Meniscus sign
- tracheal deviation
9
Q
What will you analyse the pleural fluid for after aspiration?
A
- protein
- glucose
- pH
- LDH amylase
- Bacteriology
- Cytology
- Immunology
10
Q
When will you perform a parietal pleural biopsy?
A
- if pleural fluid analysis is inconclusive
11
Q
How would you Mx pleural effusion?
A
- Tx underlying cause - if small effusion
- Pleural aspiration - temporary relief
- Chest drain - if symptomatic
- Pleurodesis - for recurrent effusion
12
Q
What is empyema?
A
- Infected pleural cavity
13
Q
When will you suspect empyema?
A
- pneumonia improving but fever ongoing
14
Q
What will the pleural aspiration features be for empyema?
A
- pH <7.2
- low glucose
- high LDH
15
Q
Chest drain is only inserted when the diagnosis is well established. Why?
A
- HInder opportunity to otain pleural biopsies
