Pleural Effusions

Question 1

What is a pleural effusion?

Answer 1

Effusion: abnormal collection of fluid in the pleural space.

Empyema: Pus in the pleural space.

Haemothorax: blood in the pleural space.

Question 2

Exudate vs transudate?

Answer 2

Transudate = <30 of protein

Exudate = >30 protein

Question 3

Examples of transudate (<30g/l)

Answer 3

Heart failure
Liver cirrhosis
Hypoalbuminaeami
Atelectasis

Question 4

Examples of exudates >30g/L

Answer 4

Malignancy
Infection including TB
Pulmonary infarct
Asbestos

ALWAYS LOOK FOR A SERIOUS PATHOLOGY

Question 5

In what context is glucose low in pleural effusion?

Answer 5

In infection, TB, RA, malignancy, oesophageal rupture, SLE.

Question 6

Fluid pH of pleural effusion?

Answer 6

Normal approx 7.6
<7.3 suggests pleural inflammation.
<7.2 requires drainage in the setting of infection.

DO NOT check if frank pus.

Question 7

Investigations of pleural effusion?

Answer 7

CXR: blunting of costophrenic angle.

Water dense shadows with concave upper borders.

Empyema = D sign on x-ray.

Question 8

Management of effusion?

Answer 8

Treat underlying cause.

Acute; chest drain.

Chronic; pleurodesis with the likes of TALC (sclerosing agent)