Pleural Effusion (not a condition, I know shush) Flashcards
What is a pleural effusion?
Abnormal collection of fluid in the pleural space
Straw-coloured effusion indicates?
Cardiac failure
Hypoalbuminaemia
Bloody effusion indicates?
Trauma
Malignancy
Infection
Infarction
Turbid/milky effusion indicates?
Empyema
Chylothorax
Foul-smelling effusion indicates?
Anaerobic empyema
Food particles in an effusion indicated?
Oesophageal rupture
What does transudate means?
Low protein (<30 g/L)
What causes transudate pleural effusions?
Cardiac failure Hypoproteinaemia (cirrhosis, nephrotic syndrome, malabsorption) Hypoalbuminaemia Atelectasis Peritoneal dialysis
What does exudate mean?
High protein (>30 g/L)
What causes exudate pleural effusion?
Increased leakiness of pleural cavity secondary to infection Pneumonia TB Connective tissue disease Malignancy RA SLE Asbestos
What characterises a simple para-pneumonic effusion?
Clear fluid
pH > 7.2
LDH <1000
Glucose > 2.2
What characterises a complicated parapneumonic effusion?
pH <7.2
LDH > 1000
Glucose <2.2
Complicated parapneumonic effusions require?
Chest tube drainage
How do you identify a pleural effusion on CXR?
D-sign
What are symptoms of a pleural effusion?
Chest pain
Cough
Fever
Breathlessness
What are signs of pleural effusion?
Decreased chest expansion
Stony dull percussion note
Decreased breath sounds on affected side
Decreased vocal remits + vocal resonance
Which tests can be performed?
CXR
USS
Aspiration
(Biopsy (if aspiration inconclusive))
What would be seen on CXR with a small pleural effusion?
blunted costodiaphragmatic angles
What would be seen on CXR with a larger pleural effusion?
Water-dense shadows with concave upper corders
How can a pleural effusion be resolved?
Thoracentesis
Tube thoracotomy
Virtually all cancers may metastasise to the pleura. How do you treat malignant effusions?
Palliate symptoms Repeated pleural taps Drain and/or pleurodesis Long-term pleural catheter Surgery (abrasion / pleurectomy)
What is Pulmonary Oedema?
Accumulation of fluid in the lung interstitium +/- alveolar spaces
What kind of defect is pulmonary oedema and subsequently what type of spirometry does it show?
Restrictive
What causes pulmonary oedema?
ncreased hydrostatic pressure
Cellular injury to alveolar lining cells or alveolar endothelium from localised pneumonia or ARDS
