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Pleural effusion Flashcards Preview

Internal Medicine > Pleural effusion > Flashcards

Flashcards in Pleural effusion Deck (12)
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1

Definition

Fluid in pleural space
Transudates = 25g/L

2

Empyema

Pus in pleural space

3

Causes- transudates

Transudates
1. +Venous pressure
a. Cardiac failure
b. Constrictive pericarditis
c. Fluid overload
2. Hypoproteinemia
a. Cirrhosis
b. Nephrotic
c. Malabsorption
d. Hypothyroidism
e. Meigs (right pleural effusion and ovarian tumor)

4

Causes exudates

+Leakiness of pleural capillaries secondary
1. Infection
a. Pnuemonia
b, TB

2. Inflammation
a. Pulmonary infarction
b. Rheumatoid arthritis
c. SLE

3. Malignancy
a. Bronchogenic carcinoma
b. Malignant metastases
c. Lymphoma
d. Medothelioma

5

Symptoms

1. May be asymptomatic
2. Dyspnea
3. Pleuritic chest pain

6

Signs

1. Decreased chest wall expansion
2. Stony dullness to percussion
3. No breath sounds at effusion
4. Bronchial breathing on effusion side
5. Tactile fremitus and vocal resonance -ve
6. If large->tracheal deviation
7. Looks for signs of underlying disease->inflammation, malignancy, infection, thyroid, RA, CCF

7

Investigations

1. CXR: blunting of costophrenic angles, larger->water dense shadows with concave upper borders
2. USS->useful to determine presence of pleural fluid and guide aspiration

8

Diagnostic aspiration

1. Percuss upper border of effusion
2. Choose site 1-2 intercostals below
3. Lidocaine
4. 21G needle, insert just above level f appropriate rib
5. Draw off fluid and send for chemistry= protein, glucose, LDH, pH amylase; MCS; cytology; immunology if indicated

9

Option if pleural fluid analysis not good

Pleural biopsy

10

Management

Is of the underlying disease

11

Fluid analysis->gross and cytology

1. Gross appearance
Clear, straw->transudate
Turbid/yellow->empyema, parapneumonic effusion
Hemorrhagic->trauma, malignancy, infarction
2. Cytology
Neutrophils->PE, empyema
LymphoC->MaligN, TB, RA, SLE, sarcoid
Mesothelial->infarction
Giant cells->RA
Lupus->SLE

12

Fluid analysis- clinical chemistry

1. Protein
Low= trans
High= ex
N, protein:serum p >0.5= ex
2. Glucose, pH, LDH
Low glucose, acidic, ++LDH= empyema, malignancy, TB, SLE
3. Elevated amylase->pancreatitis, Ca, pneumonia, esophageal rupture

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