Pleural effusion Flashcards
(30 cards)
what is pleural effusion
fluid in the pleural space
what can effusions be divided into
transudates and exudates
what is the level of protein in transudate
<25g/L
what is the level of protein in exudate
> 35g/L
what is the term for blood in the pleural space
haemothorax
what is the term for pus in the pleural space
empyema
what is the term for chyle (lymph with fat) in the pleural space
chylothorax
what is the term for blood and air in the pleural space
haemopneumothorax
what can transudates be due to
increased venous pressure, hypoproteinaemia. can also occur in hypothyroidism and Meigs syndrome (right pleural effusion and ovarian fibroma)
examples of increased venous pressure
cardiac failure, constrictive pericarditis, fluid overload
examples of hypoproteinaemia
cirrhosis, nephrotic syndrome, malabsorption
what are exudates due to
increased leakiness of pleural capillaries secondary to infection, inflammation, malignancy
causes of exudates
pneumonia, TB, pulm infarction, RA, SLE, bronchogenic carcinoma, malignant mets, lymphoma, mesothelioma
symptoms of effusion
aymptomatic, or dyspnoea, pleuritic chest pain
signs of effusion
decreased expansion, STONY dull percussion note, diminished breath sounds on affected side, decreased tactile frennitus and vocal resonance. bronchial breathing, tracheal deviation (if large effusion), aspiration marks and signs associated illness
what does the CXR show in small effusion
blunting of the costodiaphragmatic angle
what does the CXR show in a larger effusion
water dense shadows with concave upper borders
what does a completely flat horizontal upper border imply
pneumothorax
what other tests are useful other than CXR
ultrasound, diagnostic aspiration, pleural biopsy
what would you send the pleural fluid in an aspiration to the lab for
clinical chem (protein, glucose, pH, LDH, amylase); bacteriology (microscopy and culture, auramine stain, TB culture); cytology; immunology (rheumatoid factor, ANA, complement)
management
drainage (if symptomatic- slowly- 0.5-1.5L/24h-> diagnostic tap or intercostal drain); pleurodiesis (tetracycline, bleomycin, talc); intra pleural streptokinase; surgery
pleural fluid analysis: clear, straw coloured
transudate, exudate
pleural fluid analysis: turbid, yellow
empyema, parapneumonic effusion
pleural fluid analysis: haemorraghic
trauma, malignancy, pulm infarction
