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Respiratory: disorders of the pleura and chest wall > Pleural Effusion > Flashcards

Flashcards in Pleural Effusion Deck (28)
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1

what is P effusion?

an excessive accumulation of fluid in the pleural space

2

what are the causes of transudate?

may be due to increased venous pressure

or hypoproteinaemia

It also occurs in hypothydroidism and Meigs syndrome

3

what can cause increase in venous pressure?

cardiac failure, constrictive pericarditis, fluid overload

4

what causes hypoproteinaemia?

cirrhosis, nephrotic syndrome, malabsorption

5

what are the causes of exudate?

most commonly due to increased leakiness of pleural capillaries secondary to infection, inflammation or malignancy

6

what are some examples of these causes of exudate ?

pneumonia; TB; pulmonary infarction; rheumatoid arthritis; SLE; bronchogenic carcinoma; malignant metastases; lymphoma; mesothelioma; lymphangitis carcinomatosis.

7

what are the symptoms?

worsening dyspnoea
cough
pleuritic pain
or may be asymptomatic

8

what are the signs ?

decreased expansion

stony dull percussion

diminished breath sounds on the affected side

tactile vocal fremitus and vocal resonance are decreased - not as reliable

9

what may be a sign of a large effusion ?

may be tracheal deviation away from the effusion

10

what should also be done on examination

look for signs of associated disease like clubbing cachexia and stuff

11

what investigations should be done?

CXR,

and examination - only detected when more than 500 ml is present

ultrasound may be done

diagnostic aspiration

pleural biopsy

12

what can be seen on CXR of a small effusion?

small effusions blunt the costophrenic angles

13

what can be seen on CXR of a larger effusion?

they are seen as water dense shadows with concave upper borders

14

what does a flat upper border confer?

that there is a pleural effusion and a pneumothorax

15

what can stimulate a raised hemidiaphragm?

fluid below the lung ( a subpulmonary effusion)

16

what may fluid in the fissures indicate?

an intrapulmonary mass

17

what volume is needed for pleural effusion to be detected on examination

500ml

18

what are the complications of Pleural effusion?

simple parapneumonic effusion and complicated parapneumonic effusion = differentiated with aspiration cytology, serology and things

subcutaneous emphysema

haemorrhage

vagus nerve irritation

19

what happens in a complicated PPE?

the pleural space will become acidic meaning antibiotics will not work so a pus filled space forms

once in this situation it is not going to go away by itself

20

what may happen to the complicated PPE?

get empyema
this can rapidly coagulate and organise to form a fibrous peel even with antibiotics

21

what are the diagnostic features of an empyema ?

the pleural fluid will have a positive gram stain, pH

22

how should it be treated?

treat underlying cause but drain if empyema (purulent fluid).

if symptomtic or empyema drainage

pleurdesis

surgery

23

where are they commonly drained?

Thoracocentesis 5th intercostal space, mid-axillary line

24

what is pleurodesis?

a method of sticking the chest wall and pleura together

25

the fluid that accumulates may be either exudate or transudate

where are transudate normally seen

what is the protein content, lactic dehydrogenase, fluid to serum LDH ratio ?

can be bilateral but are often larger on the right side.

The protein content is

26

what are some causes of transudate effusions?

heart failure

hypoproteinemia (nephrotic syndrome)

constrictive pericarditis

hypothyroidism

ovarian tumours producing
right sided pleural effusion

27

what is the protein content, lactic dehydrogenase of exudate?

protein content is >30g/L
lactic dehydrogenase >200IU/L

28

what are the causes?

Pneumonia, cancer (fluid may be blood stained) , TB, autoimmunity, MI, pancreatitis