Pleural Effusion

Question 1

How do we seperate exudate and transudate pleural effusions?

Answer 1

An Exudate contains >30g/L of protein

A Transudate contains <30g/L of protein

Question 2

What is an exudate pleural effusion?

Answer 2

Fluid leaking out capillaries with an increased permeability, often due to inflammation

Question 3

What is a transudate pleural effusion?

Answer 3

Fluid forced out capillaries due to high venous pressure.

Question 4

What are the common symptoms/signs of pleural effusion?

Answer 4

Symptoms - Chest pain, Dyspnoea
Signs - Reduced chest expansion & vocal resonance, stony dullness to percussion and increased jugular venous pressure (JVP).

Question 5

What are the common causes for a transudate effusion?

Answer 5

Left Ventricular Failure
Liver Cirrhosis (leads to low albumin)
Hypoalbuminaemia
Peritoneal Dialysis

Question 6

What are the common causes of an exudate effusion?

Answer 6

Malignancy
Pneumonia or Abscess
Pulmonary Embolism
Autoimmune
Pancreatitis

Question 7

What investigation is done to confirm a pleural effusion?

Answer 7

A CXR

Question 8

What investigation is done to determine the type/cause of the effusion/

Answer 8

An aspiration. 50ml is removed with a 21G needle and tested.

Question 9

Waht are the complications of aspirating a pleural effusion?

Answer 9

haemothorax
Air embolism
Pulmonary Oedema
Pneumothorax, empyema

Question 10

What can you tell just from looking at a sample of aspirated pleural effusion?

Answer 10

Foul smell - Anaeorbic empyema
Food - Oesophageal Rupture
Milky - Chylothorax
Blood Stained - Malignancy, haemothorax, trauma

Question 11

What can we test an aspiration sample for in the lab?

Answer 11

Increased amylase - Pancreatitis
Protein level - exudate/transudate
Bacterial cultures
Malignant cells, lymphocytes and eosinophils

Question 12

How do we distinguish between exudate & transudate when its very close to the tipping point?

Answer 12

If an of Light’s criteria are met its an exudate:
pleural/serum protein > 0.5
Pleural/Serum LDH > 0.6
Pleural/Serum(upper limit) LDH > 0.66

Question 13

What tests can be done for a pleural effusion?

Answer 13

• CXR
• CT
• Pleural Aspiration
• Pleural Biopsy

Question 14

What kind of pleural effusion is unilateral vs bilateral?

Answer 14

Exudates are often unilateral

Transufates are oftem bilateral

Question 15

How do we treat a pleural effusion?

Answer 15

The fluid must be drained. Patient’s bed at 45 degrees with arm above head. drain in 4 Intercostal space in mid-axillary line.
Pleurodhesis can be performed if repeat offender. (talc poudrage)