Pleural Effusion and Pleural Disease Flashcards
What is a pleural effusion?
Collection of fluid in the pleural cavity
What are the types of pleural effusion?
Exudative - high protein count (>3g/dL)
Transudative - relatively lower protein count (<3g/dL)
Exudative causes of pleural effusion
Related to inflammation (protein leaking out of tissues into pleural space)
Lung cancer
Pneumonia
Rheumatoid arthritis
Tuberculosis
Transudative causes of pleural effusion
Related to fluid moving across the pleural space
Congestive cardiac failure
Hypoalbuminaemia
Hypothroidism
Meig’s syndrome (right sided pleural effusion with ovarian malignancy)
Presentation of pleural effusion
Shortness of breath
Dullness to percussion over the effusion
Reduced breath sounds
Tracheal deviation away from the effusion if it is massive
Investigations in pleural effusion
CXR
Pleural fluid aspiration/chest drain
CXR findings in pleural effusion
Blunting of the costophrenic angle
Fluid in the lung fissures
Larger effusions will have a meniscus (curving upwards where it meets the chest wall and mediastinum)
Tracheal and mediastinal deviation if it is a massive effusion
What is pleural fluid analysed for?
Protein count
Cell count
pH
Glucose
LDH
Microbiology testing
Management of pleural effusion
Conservative management may be appropriate as small effusions will resolve with treatment of the underlying cause
Larger effusions often need aspiration or drainage (pleural aspiration/chest drain)
What is empyema?
Infected pleural effusion
What to suspect in patient with improving pneumonia but new or ongoing fever
Empyema
What does pleural aspirate show in empyema?
Pus
Acidic pH (pH < 7.2)
Low glucose
High LDH
Management of empyema
Chest drain to remove pus
Antibiotics
