Pleural Effusion Flashcards
What is a Pleural Effusion?
Fluid in the pleural space
What are the two main divisions of pleural effusions?
Transudates (protein <30g/L)
Exudates (protein >30g/L)
What are the causes of transudative pleural effusions?
Increased venous pressure (cardiac failure) Hypoproteinaemia (cirrhosis) Hypothyroidism Meigs' syndrome Renal failure Peritoneal dialysis
What are the causes of exudative pleural effusions?
Increased leakiness of pleural capillaries secondary to
- Infection
- Inflammation
- Malignancy
- PE
- Autoimmune disease (RA/SLE)
- Pancreatitis/subphrenic abscess
What are the typical presenting symptoms of a pleural effusion?
Asymptomatic OR
Dyspnoea
Pleuritic chest pain
What are the typical presenting signs of a pleural effusion?
Decreased expansion Stony dull on percussion Diminished breath sounds Decreased vocal resonance Bronchial breathing above Tracheal deviation away
What is Empyema?
Pus in the pleural space
What is the clinical presentation of an empyema?
CXR indicating pleural effusion Recurrent fever Aspirated pleural fluid yellow and turbid w/ -pH <7.2 -decreased glucose -increased LDH
What is the most common cause of empyema?
Inflammation of pleura by adjacent pneumonia causes effusion - becomes infected - empyema
What signs of a pleural effusion would be present on a CXR?
Small effusions blunt costophrenic angles
Large effusions are dense shadows with meniscus sign
When should a pleural tap/biopsy be performed?
If the clinical picture suggests an exudate, or suspected transudate does not respond to treatment
What types of collection may accumulate in the pleural space?
Empyema/Pyothorax - Accumulation of pus, due to infection
Chylothorax - Accumulation of lymph, due to thoracic duct leakage
Haemothorax - Accumulation of blood, due to trauma
Pleural Effusions - Accumulation of fluid
What is pleurisy?
Inflammation of the pleura, most commonly due to infection
How should empyema be treated?
IV a/b
Chest drain
What is the difference b/w unilateral & bilateral effusions?
Unilateral - More likely to be exudative
Bilateral - More likely to be transudative
