Plural Effusions Flashcards
What does plural effusions result from
Imbalance between fluid formation and resorption within the plural space
symptoms of Plural effusions
dyspnea, trepopnea, orthopnea, cough, or chest pain
plural effusions imaging studies
chest radiographs, computed tomography [CT], ultrasonography and analyses of pleural fluid
physical examination are suggestive of pleural effusion
decreased breath sound with dullness on percussion
what is performed in the assessment of pleural effusion
Posteroanterior chest radiography
how do Pleural effusions ≥200 mL normally exhibit on chest radiographs
an abnormal opacity with decreased lung volume
what can effusions of as little as 50 mL cause on chest radiographs
blunting of the costophrenic angle
what is gold standard investigation to diagnose a pleural effusion
ultrasonography
what can Ultrasonography detect within the pleural space with greater sensitivity than CT
fibrin and septations
when can ultrasonography be used to minimizing procedure-related complications and increases the success rate
during thoracentesis
when is Chest CT with contrast is useful
for the evaluation of exudative pleural effusions
critical findings of Chest CT with contrast
malignant effusion, mesothelioma, complications of lung infection (parapneumonic effusion, empyema), and vascular or lymphatic obstruction
what is critical in characterizing the type of pleural effusion
Pleural fluid analysis
Pleural effusion may appear as
serous, serosanguinous, bloody, purulent, or milky
when is putrid purulent fluid seen
anaerobic empyema
when is milky fluid seen
chylothorax or pseudochylothorax
when is bile-stained fluid seen
biliary-pleural fistula
what are the Results of pleural fluid analysis are used for
categorize pleural effusion as transudative and exudative using Light’s criteria
Light’s criteria
are highly sensitive for an exudative process (sensitivity, 98%; specificity, 83%)
what are Pleural fluid differential cell counts helpful in
the differential diagnosis but not disease-specific
Neutrophil predominance in Pleural fluid differential cell counts
– Parapneumonic effusion
– Pulmonary embolism
– Early tuberculous pleuritis
– Benign asbestos pleural effusion
Lymphocyte predominance in Pleural fluid differential cell counts
– Malignancy – Tuberculous pleuritis – Lymphoma – Cardiac failure – After coronary bypass graft – Rheumatoid effusion – Chylothorax – Uremic pleuritis – Sarcoidosis – Yellow nail syndrome – Pulmonary embolism
Eosinophilia (≥10% of nucleated cells) in Pleural fluid differential cell counts #Pleural eosinophilia is a relatively nonspecific finding.#
– Parapneumonic effusion – Drug-induced pleuritis – Benign asbestos pleural effusion – Eosinophilic granulomatosis with polyangiitis – Lymphoma – Pulmonary embolism – Parasitic infestation – Malignancy
what is Chylothorax
pleural effusion caused by the leakage of lymphatic fluid into the pleural space from a ruptured thoracic duct or obstruction of the lymphatic vessels.
what causes Chylothorax
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
on what basis is Chylothorax Diagnosis made
pleural fluid analysis
Chylothorax appearance
The fluid is milky-white and odorless and contains chylomicrons
Chylothorax level of triglycerides is
> 1.24 mmol/L (110 mg/dL)
Chylothorax level of cholesterol is
<2.59 mmol/L (100 mg/dL).
does Chylothorax contain cholesterol crystals
no
Chylothorax has to be differentiated from
pseudochylothorax
what causes pseudochylothorax
it occurs very rarely and is a result of the accumulation of cholesterol in a chronic pleural effusion
examples of chronic pleural effusion that causes pseudochylothorax
tuberculosis or rheumatoid arthritis
pseudochylothorax appearance
has the same appearance as in chylothorax
pseudochylothorax level of cholesterol is
> 5.18 mmol/L (200 mg/dL)
pseudochylothorax level of triglycerides is
<0.56 mmol/L (50 mg/dL).
does pseudochylothorax contain cholesterol crystals
yes
Treatment of chylothorax and pseudochylothorax
pleural drainage and management of the underlying disturbances
what diet is recommended for chylothorax
high-protein low-fat (<10 g/d) diet
why is Total parenteral nutrition used for chylothorax
to reduce lymph production
what is done when oral therapy is insufficient for chylothorax
close the fistula between the lymph vessel and the pleural space
adjunctive therapies for chylothorax
Somatostatin and octreotide
In two-thirds of patients chylothorax resolves after
12 to 14 days
what is is an indication for surgical treatment
A constant lymph outflow >500 mL/d
