Pleural effusion

Question 1

Presentation

Answer 1

?deviated trachea
Reduced chest expansion, stony dull percussion, reduced vocal fremitus, reduced breath sounds

Question 2

Exudative causes

Answer 2

Protein >30g/l
-Neoplasm - lung CA, secondary
- Connective tissue disease - RA, SLE
- Infection - pneumonia, TB
- Sub-diaphragmatic - pancreatitis, hepatic abscess
- Drugs
- Other - oesophageal rupture, Dressler’s, yellow nail syndrome

Question 3

Transudative causes

Answer 3

Protein <25g/L
- CCF
- Hypoalbuminaemia
- Liver failure
- Renal failure
- Hypothyroidism

Question 4

Light’s criteria

Answer 4

Protein 25-35g/L
Exudative IF:
- pleural fluid protein:serum protein >0.5
- pleural fluid LDH:serum LDH >0.6
pleural fluid LDH > 2/3 of the upper limit of normal

Question 5

LDH >1000iU/L causes

Answer 5

Empyema
Malignant effusion
Rheumatoid effusion

Question 6

Causes of haemorrhagic effusions

Answer 6

Malignancy
PE
TB
Chest trauma

Question 7

Chylothorax

Answer 7

Milky-white fluid, >4g/l cholesterol
Causes - lymphatic obstruction, lymphatic damage, nephrotic syndrome, cirrhosis

Question 8

Causes of low glucose

Answer 8

malignancy, empyema, TB, oesophageal rupture, RA, SLE

Question 9

Normal pleural fluid

Answer 9

pH 7.6-7.64
protein 1-2 g/L
WCC <1000/mm3
LDH <50% of plasma
Glucose - similar to plasma

Question 10

pH <7.3

Answer 10

empyema, malignancy

Question 11

Elevated amylase

Answer 11

Pancreatitis
Malignancy
Bacterial pneumonia
Oesophageal rupture

Question 12

Chemical pleurodesis

Answer 12

Tacl, doxycycline, bleomycin

Question 13

Investigation

Answer 13

• Bloods incl. autoimmune profile, TFTs
• CXR
• Pleural tap - protein, LDH, glucose, pH, amylase, cholesterol, cytology