Pleural Effusion Flashcards
What is pleural effusion?
- Fluid accumulation in pleural cavity
What are the two types of effusion?
- Exudate
- pleural protein >30g/L
- Transudate
- pleural protein <30g/L
What causes exudate effusion?
- malignancy
- infection
- pneumonia, TB, HIV
- inflammation
- RA, benign asbestos effusion
What causes transudate effusion?
- HF
- Cirrhosis
- Hypoalbuminamia
- Hypothyroidism
- PE
- Meig’s syndrome (R sided pleural effusion + ovarian malignancy)
What are the sx of pleural effusion?
- Asymptomatic
- Dyspnoea
- Pleuritic chest pain
What are the clinical signs of pleural effusion?
- Decrease expansion
- Stony dull precussion
- Reduced breath sounds
- Tracheal deviation (if massive effusion)
What Ix would you order for Pleural effusion?
- Imaging
- CXR
- USS
- Special test
- Diagnostic aspiration
- Pleural biopsy
- thoracoscopic/CT guided pleural biopsy
What are the CXR features of pleural effusion?
- blunting of costophrenic angle
- fluid in lung fissures
- If large/massive effusion
- Meniscus sign
- tracheal deviation
What will you analyse the pleural fluid for after aspiration?
- protein
- glucose
- pH
- LDH amylase
- Bacteriology
- Cytology
- Immunology
When will you perform a parietal pleural biopsy?
- if pleural fluid analysis is inconclusive
How would you Mx pleural effusion?
- Tx underlying cause - if small effusion
- Pleural aspiration - temporary relief
- Chest drain - if symptomatic
- Pleurodesis - for recurrent effusion
What is empyema?
- Infected pleural cavity
When will you suspect empyema?
- pneumonia improving but fever ongoing
What will the pleural aspiration features be for empyema?
- pH <7.2
- low glucose
- high LDH
Chest drain is only inserted when the diagnosis is well established. Why?
- HInder opportunity to otain pleural biopsies
What is the only indication for urgent chest drain?
- if empyema present
What criteria is used when pleural fluid protein is boderline (between 25-35)?
- Light’s criteria
What is Light’s criteria?
- Exudate if
- Pleural fluid protein > 0.5
- Pleural fluid LDH > 0.6
- Pleural fluid LDH > 2/3 of the upper limit of normal
