pleural effusion

Question 1

pleural effusion

Answer 1

collection of fluid in pleural cavity

can be exudative or trasnudative

Question 2

exduate

Answer 2

higher protein count (35)

inc leakiness of capillaries - infection, inflammation, malignancy

Question 3

transudate

Answer 3

lower protein count <25

fluid moving across pleural space - inc venous congestion or hyponatraemia

Question 4

exudative causes

Answer 4

lung cancer
pneumonia 
rheumatoid arthritis
TB 
malignant mets

Question 5

transudative causes

Answer 5

congestive heart failure 
hypoalbuminaemia 
nephrotic syndrome 
hypothyroidism 
Meig's syndrome

Question 6

Meig’s syndrome

Answer 6

R sided pleural effusion w ovarian malignancy

Question 7

presentation

Answer 7

SOB 
pleuritic chest pain 
dullness to percussion 
reduced breath sounds
reduced expansion 
tracheal deviation

Question 8

CXR findings

Answer 8

blunting of costophrenic angle
fluid in lung fissures
meniscus - curving upwards to meet chest wall and mediastinum
tracheal + mediastinal deviation

Question 9

Mx

Answer 9

conservative if small - treat underlyign cause

pleural aspiration
chest drain

Question 10

empyema

Answer 10

infected pleural effusion

Question 11

when to suspect empyema

Answer 11

pt w improving pneumonia but new/ongoing fever

Question 12

empyema - pleural aspiration findings

Answer 12

pus
acidic
low glucose
high LDH

Question 13

empyema Mx

Answer 13

chest drain

antibiotics

Question 14

The triangle of safety for chest drain insertion

Answer 14

the base of the axilla
lateral edge pectoralis major
5th intercostal space
anterior border of latissimus dorsi