Plural Effusions

Question 1

What does plural effusions result from

Answer 1

Imbalance between fluid formation and resorption within the plural space

Question 2

symptoms of Plural effusions

Answer 2

dyspnea, trepopnea, orthopnea, cough, or chest pain

Question 3

plural effusions imaging studies

Answer 3

chest radiographs, computed tomography [CT], ultrasonography and analyses of pleural fluid

Question 4

physical examination are suggestive of pleural effusion

Answer 4

decreased breath sound with dullness on percussion

Question 5

what is performed in the assessment of pleural effusion

Answer 5

Posteroanterior chest radiography

Question 6

how do Pleural effusions ≥200 mL normally exhibit on chest radiographs

Answer 6

an abnormal opacity with decreased lung volume

Question 7

what can effusions of as little as 50 mL cause on chest radiographs

Answer 7

blunting of the costophrenic angle

Question 8

what is gold standard investigation to diagnose a pleural effusion

Answer 8

ultrasonography

Question 9

what can Ultrasonography detect within the pleural space with greater sensitivity than CT

Answer 9

fibrin and septations

Question 10

when can ultrasonography be used to minimizing procedure-related complications and increases the success rate

Answer 10

during thoracentesis

Question 11

when is Chest CT with contrast is useful

Answer 11

for the evaluation of exudative pleural effusions

Question 12

critical findings of Chest CT with contrast

Answer 12

malignant effusion, mesothelioma, complications of lung infection (parapneumonic effusion, empyema), and vascular or lymphatic obstruction

Question 13

what is critical in characterizing the type of pleural effusion

Answer 13

Pleural fluid analysis

Question 14

Pleural effusion may appear as

Answer 14

serous, serosanguinous, bloody, purulent, or milky

Question 15

when is putrid purulent fluid seen

Answer 15

anaerobic empyema

Question 16

when is milky fluid seen

Answer 16

chylothorax or pseudochylothorax

Question 17

when is bile-stained fluid seen

Answer 17

biliary-pleural fistula

Question 18

what are the Results of pleural fluid analysis are used for

Answer 18

categorize pleural effusion as transudative and exudative using Light’s criteria

Question 19

Light’s criteria

Answer 19

are highly sensitive for an exudative process (sensitivity, 98%; specificity, 83%)

Question 20

what are Pleural fluid differential cell counts helpful in

Answer 20

the differential diagnosis but not disease-specific

Question 21

Neutrophil predominance in Pleural fluid differential cell counts

Answer 21

– Parapneumonic effusion
– Pulmonary embolism
– Early tuberculous pleuritis
– Benign asbestos pleural effusion

Question 22

Lymphocyte predominance in Pleural fluid differential cell counts

Answer 22

– Malignancy
– Tuberculous pleuritis
– Lymphoma
– Cardiac failure
– After coronary bypass graft
– Rheumatoid effusion
– Chylothorax
– Uremic pleuritis
– Sarcoidosis
– Yellow nail syndrome
– Pulmonary embolism

Question 23

Eosinophilia (≥10% of nucleated cells) in Pleural fluid differential cell counts  
#Pleural eosinophilia is a relatively nonspecific finding.#

Answer 23

– Parapneumonic effusion
– Drug-induced pleuritis
– Benign asbestos pleural effusion
– Eosinophilic granulomatosis with polyangiitis
– Lymphoma
– Pulmonary embolism
– Parasitic infestation
– Malignancy

Question 24

what is Chylothorax

Answer 24

pleural effusion caused by the leakage of lymphatic fluid into the pleural space from a ruptured thoracic duct or obstruction of the lymphatic vessels.

Question 25

what causes Chylothorax

Answer 25

Malignancy (most commonly lymphoma or metastases of other cancers); injury, including surgery (particularly of the esophagus), chest trauma, sometimes catheterization of the superior vena cava; lymphangioleiomyomatosis; obstruction of a vena cava; amyloidosis

Question 26

on what basis is Chylothorax Diagnosis made

Answer 26

pleural fluid analysis

Question 27

Chylothorax appearance

Answer 27

The fluid is milky-white and odorless and contains chylomicrons

Question 28

Chylothorax level of triglycerides is

Answer 28

> 1.24 mmol/L (110 mg/dL)

Question 29

Chylothorax level of cholesterol is

Answer 29

<2.59 mmol/L (100 mg/dL).

Question 30

does Chylothorax contain cholesterol crystals

Answer 30

no

Question 31

Chylothorax has to be differentiated from

Answer 31

pseudochylothorax

Question 32

what causes pseudochylothorax

Answer 32

it occurs very rarely and is a result of the accumulation of cholesterol in a chronic pleural effusion

Question 33

examples of chronic pleural effusion that causes pseudochylothorax

Answer 33

tuberculosis or rheumatoid arthritis

Question 34

pseudochylothorax appearance

Answer 34

has the same appearance as in chylothorax

Question 35

pseudochylothorax level of cholesterol is

Answer 35

> 5.18 mmol/L (200 mg/dL)

Question 36

pseudochylothorax level of triglycerides is

Answer 36

<0.56 mmol/L (50 mg/dL).

Question 37

does pseudochylothorax contain cholesterol crystals

Answer 37

yes

Question 38

Treatment of chylothorax and pseudochylothorax

Answer 38

pleural drainage and management of the underlying disturbances

Question 39

what diet is recommended for chylothorax

Answer 39

high-protein low-fat (<10 g/d) diet

Question 40

why is Total parenteral nutrition used for chylothorax

Answer 40

to reduce lymph production

Question 41

what is done when oral therapy is insufficient for chylothorax

Answer 41

close the fistula between the lymph vessel and the pleural space

Question 42

adjunctive therapies for chylothorax

Answer 42

Somatostatin and octreotide

Question 43

In two-thirds of patients chylothorax resolves after

Answer 43

12 to 14 days

Question 44

what is is an indication for surgical treatment

Answer 44

A constant lymph outflow >500 mL/d