Pleural Effusions

Question 0

Causes of Transudate pleural effusion

Answer 0

Left ventricular failure/heart failure (usually bilateral)
Hypoalbuminaemia (malnutrition, cirrhosis, nephrotic syndrome or general protein loss)
Meigs syndrome
Hypothyroidism

Question 1

Pleural effusion

Answer 1

Collection of fluid in pleural space

Transudative (protein 35g/L)

Question 2

Causes of Exudate pleural effusion

Answer 2

Pneumonia (unilateral)
Pulmonary infarction/PE
Rheumatoid arthritis
Malignancy

Question 3

Appearance of pleural effusion

Answer 3

Clear--> transudate
Blood--> haemothorax
Chyle/milky --> chylothorax
Pus--> empyema
'Anchovy sauce'--> amoebic abscess

Question 4

CXR findings in pleural effusions

Answer 4

Small: blunt costophrenic angles
Large: water dense shadows with concave borders
With pneumothorax: flat horizontal border

Question 4

Treatment of pleural effusions

Answer 4

Drain

Talc if recurrent

Question 5

Neutrophils ++ in pleural effusion

Answer 5

Parapneumonic effusion, PE

Question 6

Lymphocytes ++ in pleural effusion

Answer 6

Malignancy, TB, RA, SLE, sarcoidosis

Question 7

Mesothelial cells ++ in pleural effusion

Answer 7

Pulmonary infarction

Question 8

Abnormal mesothelial cells in pleural effusion

Answer 8

Mesothelioma

Question 9

Multinucleated giant cells in pleural effusion

Answer 9

RA

Question 10

Glucose <3.3mmol/L in pleural effusion

Answer 10

Empyema, malignancy, TB, RA, SLE

Question 11

pH <7.2 in pleural effusion

Answer 11

Empyema, malignancy, TB, RA, SLE

Question 12

High LDH in pleural effusion

Answer 12

Empyema, malignancy, TB, RA, SLE

Question 13

High amylase in pleural effusion

Answer 13

Pancreatitis, Ca, bacterial pneumonia, oesophageal rupture