pleural effusion

Question 1

what is a pleural effusion

Answer 1

accumulation of fluid within the pleural space

Question 2

what are the 2 types of pleural effusion

Answer 2

transudative or exudative

Question 3

describe a transudative pleural effusion

Answer 3

transudate - fluid leakage

caused by disturbances in oncotic pressure, commonly caused by cardiac failure and liver cirrhosis

fluid has a low protein content (<30g/L)

Question 4

describe an exudative pleural effusion

Answer 4

exudate - fluid and protein leakage

fluid has left the circulatory system and have gone into a lesion or area of inflammation - commonly as a result of to malignancy or infection

fluid has a high protein content (>30g/L)

Question 5

describe the symptoms of a pleural effusion

Answer 5

chest pain
dry cough
dyspnoea
difficulty taking deep breaths

Question 6

what are the clinical signs of a pleural effusion

Answer 6

reduced chest expansion on the effected side

stony dull percussion

Question 7

what are the investigations used in pleural effusion

Answer 7

CXR- >500ml will cause a clear fluid level
thoracocentesis
pleural biopsy - if diagnosis is not possible from fluid sampling

Question 8

describe the fluid colours seen in thoracocentesis for pleural effusion and what they indicate

Answer 8

straw coloured - cardiac failure, hypoalbuminaemia

bloody - trauma, malignancy, infection, infarction

turbid/ milky - empyema, chylothorax

foul smelling - anaerobic empyema

food particles - oesophageal rupture

Question 9

describe cytology in thoracocentesis for pleural effusion

Answer 9

lymphocytes indicate malignancy or TB

neutrophils indicate an acute process

Question 10

describe the microbiological tests used on the fluid from thoracocentesis of a pleural effusion

Answer 10

gram stain
microscopy
culture
PCR
AFB (acid fast bacterial) stain

Question 11

what does the pH of the fluid collected after thoracocentesis in pleural effusion

Answer 11

> 7.2 = simple effusion
<7.2 = complicated effusion

Question 12

what does low glucose in the fluid collected from thoracocentesis in pleural effusion indicate

Answer 12

infection, TB, malignancy

Question 13

outline the management of pleural effusion

Answer 13

treat the underlying disorder

infection - simple can be treated with just antibiotics, complicated needs antibiotics and a chest drain