Pleural Effusion

Question 1

Blood in pleural space ?
Pus in the pleural space?
Chyle (lymph with fat) ?

Answer 1

Blood in pleural space = haemothorax.
Pus in the pleural space = empyema.
Chyle (lymph with fat) = chylothorax.

Question 2

Clear/straw coloured ?
Turbid, yellow ?
Haemorrhagic ?

Answer 2

Clear/straw coloured = transudate/exudate
Turbid, yellow = empyema
Haemorrhagic = trauma, malignancy

Question 3

• Fluid is best removed slowly - what rate?

Answer 3

(0.5-1L/hr)

Question 4

diagnostic aspiration should be performed with a?

Answer 4

a green 21G needle and a 50ml syringe

Question 5

what ix increases the likelihood of successful pleural aspiration and is sensitive for detecting pleural fluid septations

Answer 5

USS

Question 6

what amount of protein determines whether it is transudate or exudate?

Answer 6

exudates have a protein level of >30 g/L

transudates have a protein level of <30 g/L

Question 7

if the protein level is between 25-35 g/L, what criteria should be applied.

Answer 7

Light’s

Question 8

Other characteristic pleural fluid findings:

low glucose:?
raised amylase: ?
heavy blood staining: ?

Answer 8

low glucose: rheumatoid arthritis, tuberculosis
raised amylase: pancreatitis, oesophageal perforation
heavy blood staining: mesothelioma, pulmonary embolism, tuberculosis

Question 9

Pleural infection

fluid is purulent or turbid/cloudy?

if fluid is clear but pH <7.2 in patients wiht suspected pleural infection - what do you do?

Answer 9

a chest tube should be placed to allow drainage

insert chest tube for drainage

Question 10

An elderly patient with a history of chronic obstructive pulmonary disease is admitted following an infective exacerbation. The posteroanterior (PA) chest x-ray on admission shows a unilateral pleural effusion. Which one of the following is the most appropriate next line investigation?

pleural tap with USS guidance 
pleural biopsy 
computed tomography 
pleural aspiration w/ USS guide
lateral CXR

Answer 10

pleural aspiration w/ USS guide

Question 11

A 79-year-old man is admitted with a right lower lobe pneumonia. As well as showing consolidation there also appears to be a moderate sized pleural effusion on the same side. An ultrasound guided pleural fluid aspiration is performed. The appearance of the fluid is clear and is sent off for culture. Whilst awaiting the culture results, which one of the following is the most important factor when determining whether a chest tube is placed?

Glucose 
LDH 
pH
potassium 
protein

Answer 11

pH