pleural effusions

Question 1

pleural exudates - causes? specific findings in the exudate for 2 certain causes?

Answer 1

carcinoma of bronchus
infection - pneumonia, TB
PE - bloodstained exudate
RA - low glucose

Question 2

pleural transudate - causes

Answer 2

transudates are due to hypoalbuminaemia
so often accompanies ascites
eg liver disease
CCF

Question 3

what qualifies as a transudate pleural effusion?

Answer 3

protein < 30g/L

Question 4

what qualifies as an exudate pleural effusion?

Answer 4

protein > 30g/L

EXu - think EXtra protein

Question 5

commonest causes of transudate?

Answer 5

congestive cardiac failure

cirrhosis

Question 6

5 things that cause exudate pleural effusion?

Answer 6

infection - pneumonia, TB
CTD
cancer
pancreatitis
PE

infection, two Cs, two Ps

Question 7

common pleural aspirate findings - low glucose? raised amylase? bloodstained?

Answer 7

low glucose - RA, TB
raised amylase - pancreatitis, oesophageal perforation
bloodstained++ - mesothelioma, PE, TB

Question 8

LDH

Answer 8

marker of tissue damage incl haemolysis

produced by bacteria

Question 9

what is LDH?

Answer 9

marker of tissue damage eg haemolysis, sepsis, organ damage/disease, cancer, hypoxia, cancer etc

also produced by bacteria

Question 10

what is a transudate?

Answer 10

when fluid accumulation is due to an imbalance of fluid pressure inside blood vessels + the protein in the blood

Question 11

pleural effusion - who needs management/what is management?

Answer 11

pts with pleural infection (ie empyema - pus in pleural cavity), or with pleural effusion + sepsis or pneumonic illness

1) USS - ?pleural fluid septations, guide drainage
2) USS-guided aspiration with 20G needle + 50ml syringe
2) CXR
3) ± contrast CT - ?cause (esp exudate)

4) place a chest tube if:
a) fluid is purulent/turbid/cloudy, to allow drainage
b) fluid is clear, pH <7.2 + pleural infection suspected
c) organisms confirmed

USS - echo-free space between the visceral + parietal pleura
septations - infection

Question 12

what is an empyema? how does it show on aspiration?

Answer 12

after pneumonia, pt may develop a free-flowing exudate that gets infected by bacterial invasion across damaged lung epithelium. in presence of pus, this is called an empyema

turbid effusion
pH < 7.2
low glucose
high LDH

Question 13

what is an empyema? how does it show on aspiration?

Answer 13

after pneumonia, pt may develop a free-flowing exudate that gets infected by bacterial invasion across damaged lung epithelium. in presence of pus, this is called an empyema

turbid effusion
pH < 7.2
low glucose
high LDH