Pleural Effusion

Question 1

What is a pleural effusion?

Answer 1

Fluid in the pleural space

Question 2

What is the difference between pleural effusion pulmonary oedema?

Answer 2

Pleural effusion = Fluid in pleural space

Pulmonary oedema = fluid in the lung parenchyma

Question 3

What are the different types of pleural effusions?

Answer 3

Exudate and transudate

Question 4

What is the pathophysiology of Exudative pleural effusion?

Answer 4

These effusions occur when there’s increased permeability of the capillaries or damage to the pleura due to inflammation or infection. Inflammation, infection, malignancy, or trauma can lead to increased fluid and protein leakage from the damaged blood vessels and lymphatic vessels.

Question 5

What is the pathophysiology of Transudative pleural effusion?

Answer 5

These effusions result from an imbalance in hydrostatic and oncotic pressures within the capillaries. Increased hydrostatic pressure, as seen in heart failure and renal failure, or decreased oncotic pressure, as in hypoalbuminemia, can cause fluid to leak out of the capillaries and into the pleural space.

Question 6

If the pleural effusion is Transudate what investigations can we do to find the cause?

Answer 6

Heart failure effusions - Serum BNP

Liver failure - NILS and US/Fibroscan

Hypoalbuminaemia - Serum albumin

Nerphrotic syndrome - UE’s, Urine dip, and Urine Protein:creatinine Ration

Chronic Hypothyroidism - Serum TSH

Question 7

If the pleural effusion is Exudate what investigations can we do to find the cause?

Answer 7

Malignancy - Pleural cytology, CT scan, Pleural Biopsy

Pleural Infection - Serum infective markers, Pleural pH, Pleural MC&S

Pulmonary Embolism - CTPA/VQ Scan

Autoimmune pleuritis - Pleural biopsy, Serum Immunology blood tests

Question 8

How do we treat Transudate Vs Exudate pleural effusions?

Answer 8

Transudate are usually best treated by treating the underlying cause only. They, in most cases do not need to have any permanent fluid controlling pleural intervention

Exudate are also treated by treating the underlying cause but may also need definitive fluid controlling pleural intervention (i.e. chest drain)

Question 9

Which pleural effusions need respiratory input?

Answer 9

If transudate is clear from history does not need pleural intervention - treat underlying cause only.

If cause unclear then can refer to resp for further work up

If exudate effusion then all patients should be seen by respiratory.