17.) Pleural Effusion Flashcards
(14 cards)
What is pleural effusion?
Pleural effusion is fluid in the pleural space.
How is pleural effusion classified?
It’s classified based on protein concentration: transudates (below 25g/L) and exudates (over 35g/L).
What are the variants of pleural effusion?
Variants include: Haemothorax (blood), empyema (pus), chylothorax (lymph with fat), and haemopneumothorax (both blood and air).
What causes transudates?
Transudates result from increased venous pressure or hypoproteinemia, often due to conditions like cardiac failure or cirrhosis.
What causes exudates?
Exudates occur from capillary leakiness due to infection, inflammation, or malignancy, including pneumonia, TB, and cancers like bronchogenic carcinoma.
What are the symptoms of pleural effusion?
Symptoms can be asymptomatic or include dyspnea, pleuritic chest pain, cough, and sometimes fever.
What are the signs of pleural effusion?
Signs include decreased chest expansion, dull percussion note, and diminished breath sounds on the affected side.
How is pleural effusion diagnosed?
Diagnosis includes chest x-ray, ultrasound, diagnostic aspiration, and pleural biopsy.
What does a chest x-ray show for pleural effusion?
Small effusions blunt costophrenic angles, while larger ones appear as water-dense shadows with concave upper borders.
What is involved in diagnostic aspiration?
- Percussing the upper border of the effusion and selecting a site 1 or 2 intercostal spaces below it. 2. Infiltrating 5–10ml of 1% lidocaine down to the pleura. 3. Attaching a 21G needle to a syringe and inserting it just above the upper border of a rib to avoid neurovascular structures. 4. Drawing off 10–30ml of fluid for lab analysis.
Thoracentesis for pleural effusion is done above the upper border of the 8th rib (to avoid the neurovascular bundle) in the midaxillary line.
• Common site: 7th, 8th, or 9th intercostal space, midaxillary line
• Always insert the needle above the rib to avoid injury to the intercostal vessels and nerve below each rib.
How are symptomatic effusions managed?
Symptomatic effusions can be drained, preferably slowly (0.5–1.5L/24h), either via repeated aspiration or with an intercostal drain.
What is pleurodesis?
Pleurodesis is a medical procedure in which the pleural space is artificially obliterated, often using tetracycline, bleomycin, or talc for recurrent effusions.
How should empyema be drained?
Empyema is best drained using a chest drain, often under ultrasound or CT guidance.
When is surgery indicated for pleural effusion?
Surgery is indicated for persistent collections and increasing pleural thickness.
