PULMO Flashcards
Etiopathogenesis of pleural effusion
Collection of fluid ABNORMALLY PRESENT in the pleural space due to either:
A. excess fluid production
B. Decreased lymphatic absorption
Normal pleural space contains only __ mL of fluid
~10 mL
Most common cause of pleural effusion is
Left ventricular failure
General classification of pleural effusion
Transudative vs
Exudative
Type of effusion when systemic factors that influence and absorption of pleural fluid are altered
Transudative effusion
Type of effusion that occurs when LOCAL factors that influence the formation and absorption of pleural fluid are altered
Exudative effusion
Symptoms associated with pleural effusion
Pleuritic pain
Cough
Dyspnea
PE findings in pleural effusion
- Decreased breath sounds
- Decrease or absent tactile fremiti
- Fullness on percussion
- Pleural rub
- Tracheal deviation
Criteria to determine if the pleural effusion is transudative vs exudative
Light’s criteria
What diagnostic tools are important to assess for Light’s criteria
Specimen: serum and pleural fluid
- LDH
- Protein level
Other diagnostics for exudative pleural effusions
- Description and appearance of fluid
- Glucose and protein level
- Differential cell count
- Microbiologic studies and cytology
- Work up for TB
In Light’s criteria, how many of the criteria should a specimen meet to be classified as exudative
1
Light’s criteria
Enumerate
- Pleural fluid protein / serum protein >0.5
- Pleural fluid LDH/ serum LDH >0.6
- Pleural fluid LDH > 2/3 the normal upper limit for serum
Light’s criteria may misidentify ___% of transudates as exudates
25%
IF >/= 1 OF LIGHT’S CRITERIA are MET
but the patient is clinically thought to have transudative effusion
How do you settle this
The difference between the protein levels in the serum and pleural fluid should be measured
If gradient >31 g/L -> transudative
