Pleural Effusion Flashcards
What are some physical exam findings for pleural disease?
- Observation: Tachypnea, orthopnea, overt difficulty breathing, classic/rapid shallow breathing, marked abdominal effort
- Auscultation: muffled heart/lung sounds
- Underlying disease process: heart murmur/gallop sound, palpation of mediastinal mass, fever, trauma
If you localized to the pleural space, what kind of respiratory signs would you see?
- Mild muffling or heart sounds
- Decreased lung sounds
- Increased RR and effort with rapid/shallow breathing
What are some differentials for pleural space disease?
Pleural effusion, pleural space/mediastinal mass, diaphragmatic hernia, pneumothorax
This is defined as the free air in pleural space that results in loss of negative pressure
Pneumothorax
What are causes of pneumothorax?
Leaking air from lung or thoracic wall penetration
This is defined as the displacement of abdominal viscera through the diaphragm
Diaphragmatic hernia
What are some signs indicating a diaphragmatic hernia?
Respiratory signs (tachynea, respiratory distress, cyanosis), GI signs, Fluid accumulation
What kind of masses do you see in the pleural space?
Mediastinal and thoracic wall masses
What kind of imaging will help refine a differential list for pleural diseases?
Radiography and ultrasound (TFAST for trauma)
What type of pleural effusion is described and what are the causes for it?
- Protein < 2.5 g/dL, low cell count < 1500 nucleated cells/uL)
- Macrophages, some neutrophils and lymphocytes
- Color: colorless to light yellow and transparent
Pure Transudate
Causes: Increased venous pressure, lymphatic hypertension, low oncotic pressure
What type of pleural effusion is described and what are the causes for it?
- Protein 2.5-2.7 g/dL, 1,000-7,000 nucleated cells/uL
- Macrophages, some neutrophils and lymphocytes
- Color: light to moderate yellow, maybe blood-tinged and transparent to slightly cloudy
Modified Transudate
Causes: Increased venous or lymphatic pressure, inflammation of pleural vasculature
What type of pleural effusion is described and what are the causes for it?
- Protein > 3 g/dL, cell count > 7,000 nucleated cells/uL)
- Neutrophils predominate, low numbers of macrophages and few lymphocytes
- Color: purulent appearance, foul odor
Exudate
Causes: multiple infectious causes
What type of pleural effusion is described and what are the causes for it?
- Protein > 2.5 g/dL, variable cell count
- > 0.5-1 million/uL RBC with a measurable PCV
- Many RBCs
- Color: hemorrhagic appearance
Hemorrhage
Causes: Coagulopathy, bleeding neoplasia, trauma
What type of pleural effusion is described and what are the causes for it?
- Protein > 2.5 g/dL, variable cell count
- High triglycerides
- Small lymphocytes, macrophages and neutrophils
- Color: grossly white to pink, opaque
Chylous
Causes: Cardiac disease, idiopathic, neoplasia, heartworm, cranial vena caval thrombus or mass
What are some diagnostics you should run for pleural effusion?
- CBC/chem, thoracic rads, thoracocentesis with fluid analysis
