Pleural Effusion and Mesothelioma

Question 1

What are the two types of effusion?

Answer 1

Exudative > 3g/L of protein
Transudative <3g/L

Question 2

What causes exudative pleural effusion?

Answer 2

Inflammation causes protein to leak from tissue into pleural space

Causes of the inflammation are lung cancer, pneumonia, rheumatoid arthritis, tuberculosis

Question 3

What causes transudative pleural effusion?

Answer 3

Congestive cardiac failure (LV)
Liver cirrosis

Hypoalbuminaemia
Hypothyroidism
Meig’s syndrome (r. Pleural effusion, ovarian cancer, ascites)

Question 4

What’s the presentation of pleural effusions?

Answer 4

SOB
Dull percussion
Reduced breath sounds
Mediastinal shift

Question 5

What investigations can be done for pleural effusion?

Answer 5

CXR - blunting of costophrenic angle, fluid
Sample of pleural fluid by aspiration, chest drain

Question 6

How do you manage a pleural effusion?

Answer 6

Small effusion, conservative management

Larger effusion: pleural aspiration, drainage

Question 7

What is empyema?

Answer 7

Infected PE
Will find pus
pH will be low

Treated with chest drain and antibiotics

Question 8

Light’s criteria for exudate or transudate?

Answer 8

Protein : Pleural fluid /serum fluid ratio > 0.5

LDH : Pleural fluid /serum fluid ratio > 0.6

Pleural fluid LDH > 2/3 rd ULN serum LDH

Question 9

Characteristics of mesothelioma?

Answer 9

Malignancy of pleura
(pleural tumours are rarely benign)

Causes by inhaled asbestos fibres from occupation

Question 10

Symptoms of mesothelioma?

Answer 10

Breathlessness

Chest Pain

Weight loss

Clubbed , signs of a pleural effusion