pleural effusion Flashcards
protein in transudate pleural effusion
<30g/l
protein in exudate pleural effusion
> 30g/L
exudative causes of pleural effusion
related to inflammation:
- pneumonia
- cancer
- infection
- RA
- tuberculosis
- pancreatitis
- dressler’s syndrome
transudative causes of pleural effusion
congestive heart failure
hypoalbuminaemia (liver disease, nephrotic syndrome, malabsorption)
hypothyroidism
meigs syndrome
meigs syndrome
benign ovarian tumour
pleural effusion
ascites
presentation of pleural effusion
dyspnoea, non-productive cough or chest pain
examination: dullness to percussion, reduced breath sounds, reduced chest expansion
investigations in pleural effusion
PA chest x-ray
- blunting of costophrenic angle
- fluid in lung fissures
- meniscus
- tracheal and mediastinal deviation
also: USS and CT
lights criteria for exudate pleural effusion
pleural fluid protein: serum protein ration >0.5
pleural fluid LDH: serum LDH ration > 0.6
pleurasl fluid LDH more than 2/3rds the upper limits of normal serum LDH
other characteristic pleural fluid findings
low glucose: RA, tuberculosis
raised amylase: pancreatitis, oesophageal perf
low complement (C3, C4): SLE
heavy blood staining: mesothelioma, PE, tuberculosis
management of patients with pleural effusion in association with sepsis
diagnostic pleural fluid sampling:
- if fluid purulent or turbid/cloudy: chest tube placed for drainage
- if fluid clear but pH is less than 7.2 in patients with suspected pleural infection a chest tube should be placed
