Pleural Effusion Flashcards
What is a pleural effusion?
Excess fluid in the pleural cavity.
Due to imbalance of pleural fluid production and absorption.
What is transudate?
Increased formation of pleural fluid, not protein rich.
What are the causes of transudate?
- Congestive heart failure (increased hydrostatic pressure)
- Fluid overload, constrictive pericarditis
- Hypoproteinaemia - Nephrotic syndrome, liver failure (reduced oncotic pressure)
What is exudate?
Increased pleural fluid due to increased capillary permeability after inflammation. Protein rich.
What are the causes of exudate?
- Infection - pneumonia, TB
- Cancer - May also block lymph drainage
- Pulmonary infarct
What is a haemothorax?
Blood in the pleural cavity
What is chylothorax?
Fluid is chyle, leaked from the lymphatic duct
What is an empyema?
Fluid is pus
What are some symptoms of pleural effusion?
- May be asymptomatic
- If symptoms, pleuritic chest pain, dyspnoea
What are some signs of pleural effusion
- Decreased chest expansion on affected side
- Stony and dull percussion
- Reduced breath sounds on affected side
- Reduced vocal resonance
- Bronchial breathing above the effusion, where the lung is compressed
- In large effusions, may be tracheal deviation away from the effusion
What would you see on a pleural effusion on a CXR?
- Upper boarder curved like a meniscus
- Dense homogenous opacity
- Opacity in lower zone
- Cannot see diaphragm outline - blunted costophrenic angles
- (If flat, implies there is a pneumothorax)
What investigations would you do on a pleural aspirate?
- Clinical chemistry - protein, glucose, LDH, pH, amylase
- Bacteriology - MC&S
- Cytology
- Immunology if indicated
How do you manage pleural effusion?
- Treat underlying cause
- Drainage - by aspiration or intercostal drain
- Pleurodesis with talc if recurrent
If the aspirate showed low glucose, low pH and high LDH - what would your diagnosis be?
Empyema
If protein is <25g/L - what is the pleural aspirate?
Transudate
