Pleural Effusions

Question 1

Transudates can be caused by increased _______ pressure (e.g. fluid overload, constrictive pericarditis and _______)

Answer 1

Transudates can be caused by Increased Venous pressure e.g. Constrictive pericarditis, fluid overload and Cardiac failure)

Question 2

Transudates can be caused by hypoproteinaemia in conditions like ______, ______ and _______.

Answer 2

Transudates can be caused by hypoproteinemia in conditions like cirrhosis, nephrotic syndrome and malabsorption)

Question 3

Exudates are caused by increased _______ of pleural capillaries

Answer 3

Leakiness

Question 4

Causes of exudates include infection, inflammation and Malignancy… give examples of each.

Answer 4

Infection: TB, Pneumonia
Malignancy: Bronchogenic Carcinoma, Metastases, Lymphoma, mesothelioma
Inflammation: rheumatoid arthritis, SLE, pulmonary infarction.

Question 5

signs on a resp exam to look for in a pleural effusions

Answer 5

Decreased Expansion, Stony dull percussion, diminished breath sounds on affected side. Tactile fremitus and vocal resonance may be low.

Question 6

Signs to look for that may indicate malignancy

Answer 6

Cachexia, Finger clubbing, radiation marks, lymphadenopathy, mastectomy scar

Question 7

Signs to look for when assessing Pleural effusion, outwith Resp Exam and Malignancy

Answer 7

Signs of chronic / decompensated liver disease, cardiac failure, Hypothyroidism, RA, butterfly rash (SLE) - ultimately just look for causal conditions

Question 8

Usually P.effusions have a thick water-dense shadow with a concave upper border. What does a flt horizontal upper border on CXR indicate?

Answer 8

That there is a pneumothorax also present along with the effusion.

Question 9

What tests do you want to perform on diagnostic pleural effusion aspirate?

Answer 9

1) Clinical chemistry (pH, Ldh, protein, glucose, amylase)
2) Cytology (malignancy)
3) Bacteriology (Microscopy and culture, TB culture)
4) immunology (rheumatoid factor, ANA)

Question 10

Name one investigation before diagnostic aspirate and one after (if diagnositc aspirate is inconclusive)

Answer 10

Before: Ultrasound
After: Pleural biopsy

Question 11

management of Pleural effusions

Answer 11

1) Drainage - slowly (1.5-2L/24h)
2) Pleurodesis - with Tetracycline, Bleomycin or Talc.
3) surgery - repeated effusions with increasing pleural thickness on US requires surgery.

Question 12

What could be the cause of the effusion, if fluid aspriate shows low complement?

Answer 12

RA, SLE, malignancy OR infection

Question 13

What does a) Ph

Answer 13

a) Empyema, Malignancy, TB, RA, SLE

b) Empyema, Malignancy, TB, RA, SLE

Question 14

what do these effusions indicate? a) yellow, turbid fluid

b) Haemorrhagic fluid

Answer 14

a) Empyema, paraneumonic effusion

b) Trauma, Pulmonary Infarction, Malignancy