UNILATERAL PLEURAL EFFUSION Flashcards
What is a pleural effusion?
- build up of fluid in the pleural space
Is a pleural effusion bilateral or unilateral?
unilateral usually
What are pleural effusions divided/categorised by?
protein concentrations
What 2 categories are pleural effusions divided into? (2)
- transudates
2. exudates
What are transudates and what is characteristic of it? (1,3)
- extravascular fluid
- with decreased protein content
- decreased specific gravity
- decreased nucleated cell count
HIGH PRESSURE
What primary cell types are involved in transudative pleural effusion? (3)
- macrophages
- lymphocytes
- mesothelial cells
What are exudates?
any fluid that filters from the circulatory system into lesions or areas of inflammation
- lots of protein
What is the fluid like in exudative pleural effusion?
clear or pus like
What is the fluid composed of in exudative pleural effusion? (3)
- serum
- fibrin
- wbcs
What is a haemothorax?
blood in pleura
What is an empyema?
pus in pleura
What is a chylothorax?
lymphactics in pleural space
what is haemopneumothorax?
blood and air in the pleura space
What is the risk factors/causes for transudative pleural effusion? (8)
- cardiac failure
- constrictive pericarditis
- fluid overload
- cirrhosis
- nephrotic syndrome
- malabsorption
- hypothyroidism
- Meig’s syndrome
How does cardiac failure, constrictive pericarditis and fluid overload cause transudative pleural effusion?
due to increased venous pressure
How does cirrhosis, nephrotic syndrome and malabsorption cause transudative pleural effusion?
hypoproteinaemia
What is a typical presentation in Meig’s syndrome? (2)
- right pleural effusion and ovarian fibroma
What causes/is a risk factor for exudative pleural effusion? (13)
- infection
- malignancy
- inflammation
- pneumonia
- TB
- pulmonary infarction
- RA
- SLE
- bronchogenic carcinoma
- malignant metastases
- lymphoma
- mesothelioma
- lymphangitis carcinomatosis
How does infection, inflammation and malignancy cause exudative pleural effusions?
increase the leakiness of pleural capillaries
What is mesothelioma?
a rare, aggressive form of cancer of the mesothelial cells caused by asbestos
What is lymphangitis carcinomatosis?
diffuse infiltration and obstruction of pulmonary parenchyma and lymphactic channels by a tumour
What are the symptoms of pleural effusion? (2)
- shortness of breath
- pleuritic pain
What are the signs? (7)
- decreased expansion
- dull percussion
- diminished breath sounds on affected side
- decreased tactile fremitus
- decreased vocal resonance
- bronchial breathing
- tracheal deviation
In which direction is the trachea deviated in a pleural effusion?
away from the effusion
Differential diagnosis (8)
- congestive heart failure
- pulmoanry oedema
- diaphragmatic injuries
- oesophageal ruptures and tears
- lung neoplasms
- pancreatitis
- Q fever
- RA
What is Q fever?
bacterial infection caused by Coxiella burneti which is found in cattle and is passed onto humans
Investigations (4)
- CXray
- US
- aspiration - done with US guidance
- pleural biopsy
Treatment
- drain
- pleurodesis
- pleurectomy
- antibiotics
- diuretics
- pleural tap
If the cancer is the cause of pleural effusion how would you treat the pleural effusion?
treat the cancer with chemo and radiation
What is a pleurodesis?
surgical procedure which artificially obliterates the pleural space by adhering the 2 pleurae
What criteria is used to diagnose exudative pleural effusions and what does it state? (1,3)
- Light’s criteria
- Pleural fluid protein:serum protein > 0.5
- pleural fluid LDH: serum LDH > 0.6
- pleural fluid LDH > 2/3 of upper limit of normal for serum (105-333 IU/L)
How does transudative pleural effusion affect the lungs (bilaterally, unilaterally, which side?)?
- right hand side
What is the most common cause of exudative pleural effusion?
carcinoma of the bronchus
What three components are measured in pleural fluid? (3)
- LDH
- dehydrogenase
- lactate
