Pleural Effusion

Question 1

What is a pleural effusion?

Answer 1

Build-up of excess fluid between the layers of the pleura outside the lungs

Question 2

Symptoms of pleural effusion?

Answer 2

Pleuritic chest pain

SOB

Question 3

Signs of pleural effusion?

Answer 3

Decreased chest expansion
Decreased vocal resonance
Stony dull percussion
Trachea deviation AWAY from large effusion (>1L)

Question 4

How to diagnose pleural effusion?

Answer 4

CXR - blunted costophrenic angle

Pleural tap

Question 5

How to find the cause of a pleural effusion?

Answer 5

Pleural fluid protein concentration

<25g/L = transudate
>35g/L = exudate
25-35g/L = use Light's criteria to determine whether transudate/exudate

Question 6

What is a transudate?

Answer 6

Fluid build up caused by increased hydrostatic pressure or reduced plasma oncotic pressure

Question 7

Causes of transudates?

Answer 7

Congestive heart failure (increased hydrostatic pressure)
Cirrhosis (low albumin) 
Nephrotic syndrome (low albumin)

Question 8

What is an exudate?

Answer 8

Fluid build up due to inflammation and increased capillary permeability

Question 9

Causes of exudates?

Answer 9

Pneumonia

Pulmonary embolism

Question 10

What is Light’s criteria?

Answer 10

The effusion is exudative if one of the following applies:

Effusion protein/serum protein ratio > 0.5
Effusion LDH/serum LDH ratio > 0.6
Effusion LDH level > 2/3 the upper limit of the laboratory’s reference range of serum LDH

Question 11

Management of a pleural effusion?

Answer 11

Treat cause

Symptomatic effusion - drainage
Recurrent effusion - pleurodesis/surgery