Respiratory - Pleural Effusion Flashcards
What is a pleural effusion?
Collection of fluid in the pleural space
How are pleural effusion categorised?
Exudative- high protein, more than 30g/L
Transudative- lower protein, less than 30g/L
What is Light’s criteria for exudative effusion?
Protein greater than 0.5
LDH greater than 0.6
Fluid LDH greater than 2/3 of normal serum LDH
What are the exudative causes of pleural effusion?
Inflammatory
Protein leaks out of tissues into pleural space
Cancer (lung cancer or mesothelioma)
Infection (pneumonia or tb)
RA
What are the transudative causes of pleural effusion?
Fluid moves into pleural space
Congestive heart failure
Hypalbuminaemia
Hypothyroidism
Meigs syndrome
What is Meigs syndrome?
Triad of
- Benign ovarian tumour (fibroma)
- Pleural effusion
- Ascites
Symptoms resolve with removal of the tumour
How does pleural effusion present?
Shortness of breath
Dullness to percussion
Reduced breath sounds
Tracheal deviation
What investigations are used for pleural effusion?
CXR
USS and CT for smaller effusions
Pleural fluid analysis
What are the CXR findings for pleural effusion?
Blunting of costophrenic angles
Fluid in lung fissures
Meniscus signs
Tracheal deviation
How are pleural effusions treated?
Treat underlying cause
Conservative management
Pleural aspiration to relieve pressure
Chest drain to prevent it recurring
What is empyema?
Infected pleural effusion
When should empyema be suspected?
Improving pneumonia with new fever
What does pleural aspiration of empyema show?
Pus
Low pH
Low glucose
High LDH
How is empyema treated?
Chest drain
Antibiotics
