Pleural effusion

Question 1

What is a pleural effusion?

Answer 1

A collection of fluid in the pleural space

Question 2

How are pleural effusions divided, and what are the 2 divisions?

Answer 2

The protein concentration in the fluid - can be transudate (low protein) or exudate (high protein)

Question 3

1) Exudate causes of pleural effusions are linked to what?
2) Name a cause of an exudate pleural effusion
3) Transudate causes of pleural effusions are linked to what?
4) Name a cause of a transudate pleural effusion
5) What is Meig’s syndrome?

Answer 3

1) Inflammation
2) Lung cancer, pneumonia, rheumatoid arthritis and tuberculosis
3) Fluid moving across into the pleural space
4) Congestive cardiac failure, liver cirrhosis, malabsorption, fluid overload, hypothyroidism, Meig’s syndrome
5) Right sided pleural effusion with ovarian malignancy

Question 4

1) Pleural effusion is often asymptomatic but name a symptom it may present with
2) Name a sign of pleural effusion

Answer 4

1) Dyspnoea, pleuritic chest pain
2) Dullness to percussion over the effusion. reduced breath sounds, tracheal deviation in large effusions

Question 5

Name 2 investigations that may be used if suspected pleural effusion

Answer 5

• Chest x-ray
• Ultrasound
• Aspiration to analyse fluid
• Pleural biopsy

Question 6

1) What is the first aspect in the management of a pleural effusion?
2) How is a symptomatic pleural effusion managed (2)?
3) What is the difference between chest drain and aspiration in terms of treating a pleural effusion?

Answer 6

1) Treatment of the underlying cause
2) Aspiration or chest drain
3) Chest drain is permanent whereas aspiration is a temporary solution

Question 7

What is an empyema?

Answer 7

An infected pleural effusion/collection of pus in the pleural space

Question 8

1) In the pleural aspiration of an empyema, what would be seen on analysis of the fluid?
2) How is an empyema treated?

Answer 8

1) Pus, acidic pH (pH < 7.2), low glucose and high LDH
2) Chest drain

Question 9

Exudates and transudates have a protein level of what?

Answer 9

Less than 30g\L = transudates
More than30g\L = exudates

Question 10

Light’s criteria indicate that an exudative cause of a pulmonary effusion is likely if pleural fluid protein:serum protein ratio is > what OR pleural fluid LDH:serum LDH is > what?

Answer 10

• 0.5
  Or
• 0.6