pleural effusion

Question 1

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Question 2

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Question 3

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Question 4

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Question 5

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Question 6

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Question 7

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Question 8

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Question 9

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Question 10

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Question 11

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Question 12

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Question 13

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Question 14

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Question 15

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Question 16

Pleural effusion: causes translate
< 30g/L protein)

Answer 16

heart failure (most common transudate cause)
hypoalbuminaemia
liver disease
nephrotic syndrome
malabsorption
hypothyroidism

hypothyroidism
Meigs’ syndrome

Question 17

cause ofan exudate Exudate (> 30g/L protein)

Answer 17

infection :
pneumonia (most common exudate cause),
tuberculosis
subphrenic abscess

connective tissue disease :
rheumatoid arthritis
systemic lupus erythmatosus

neoplasia :
lung cancer
mesothelioma
metastases

pancreatitis

pulmonary embolism

Dressler’s syndrome

yellow nail syndrome

Question 18

x

Question 19

diagnosis of Pleural effusion ?

Answer 19

posterioranterior (PA) chest x-rays

ultrasound is recommended - increase likelihood of pleural aspirations
sensitive for detecting pleural fluid septations

Question 20

what is taken to investigate the underlying cause of pleural effusion

Answer 20

contrast CT

Question 21

pleural fluid aspiration from USG needles should be sent for what ?

Answer 21

pH,
protein,
lactate dehydrogenase (LDH), cytology
and microbiology

Question 22

what criteria was developed in 1972 to help distinguish between a transudate and an exudate ?

Answer 22

Light’s criteria

FOR BORDERLINE CASES

Question 23

what are the borderline cases ?

Answer 23

exudate protein level of >30 g/L,

transudates have a protein level of <30 g/L

protein level is between 25-35 g/L, Light’s criteria should be applied

Question 24

An exudate is likely if at least one of the following criteria are met:

Answer 24

pleural fluid protein divided by serum protein >0.5

pleural fluid LDH divided by serum LDH >0.6

pleural fluid LDH more than two-thirds the upper limits of normal serum LDH

Question 25

pleural fluid findings of low glucose

Answer 25

rheumatoid arthritis, tuberculosis

Question 26

pleural fluid findings of raised amylase

Answer 26

pancreatitis, oesophageal perforation

Question 27

pleural fluid findings of heavy blood staining

Answer 27

mesothelioma, pulmonary embolism, tuberculosis

Question 28

who requires diagnostic pleural fluid sampling

Answer 28

patients with a pleural effusion in association with sepsis or a pneumonic illness

Question 29

what determines if a chest tube should be placed due to findings in the pleural fluid ?

Answer 29

fluid is purulent or turbid/cloudy fluid is clear but the pH is less than 7.2 in patients with suspected pleural infection a chest tube should be placed

Question 30

Options for managing patients with recurrent pleural effusions include:

Answer 30

recurrent aspiration pleurodesis indwelling pleural catheter drug management to alleviate symptoms e.g. opioids to relieve dyspnoea