Pleural Effusion

Question 1

What protein count makes a pleural effusion exudative or transudative?

Answer 1

Exudative = high protein count (>30g/l)
Transudative = lower protein count (<30g/l)

Question 2

What are the causes of exudative effusion? (6)

Answer 2

PE
Lung cancer
Mesothelioma
Pneumonia
Rheumatoid.
Tuberculosis

Question 3

What are the causes of transudative effusion? (4)

Answer 3

Heart failure
Hypoalbuminaemia (liver failure/nephrotic syndrome)
Hypothyroidism
Meigs syndrome

Question 4

What is Meigs syndrome?

Answer 4

Triad of benign ovarian tumour, pleural effusion and ascites
If remove tumour then other 2 go away

Question 5

What is the presentation of pleural effusion? (4)

Answer 5

Sob
Dullness to percussion
Reduced breath sounds
Tracheal deviation away from effusion

Question 6

What is seen on a cxr in pleural effusion? (4)

Answer 6

Blunting of costophrenic angles
Fluid in fissures
Meniscus in large effusions
Tracheal and mediastinal deviation away in large effusions

Question 7

What is shown in aspiration of empyema? (4)

Answer 7

Pus
Acidic ph
Low glucose
High LDH

Question 8

What is the management of empyema?

Answer 8

Chest drain
Antibiotics

Question 9

What is the lights criteria used for?

Answer 9

Establishing an exudative effusion using protein of LDH

Question 10

What are the values in the lights criteria? (3)

Answer 10

• Pleural fluid protein / serum protein greater than 0.5
• Pleural fluid LDH / serum LDH greater than 0.6
• Pleural fluid LDH greater than 2/3 of the normal upper limit of the serum LDH