Pleural effusion Flashcards
1
Q
What is the definition of a pleural effusion?
A
Excessive accumulation of fluid in the pleural space
>500ml = clinical diagnosis
>300ml = x ray diagnosis
2
Q
How common is a pleural effusion?
A
No UK data but for the USA the annual incidence is around 250000 cases
3
Q
What is the pathology of a pleural effusion?
A
- Either transudate or exudate
- Can also consist of blood (haemothroax), pus (empyema) or lymph (chylothorax)
- Transudate:
- Hydrostatic forces favor the accumulation of pleuritic fluid
- Or movement of fluid from the peritoneum
- Exudate:
- Damaged or altered pleura
- = loss of tissue fluid and protein
- Impaired lymphatic drainage of the pleural space
- Effusion protein/serum protein ratio > 0.5
- Massive effusion = most likely malignant
4
Q
What are the risk factors/aetiology of pleural effusions?
A
- Transudate:
- Heart failure
- Hypothyroidism
- Pericarditis
- Ovarian fibromas (Meigs’ syndrome – causes right sided effusion)
- Exudate:
- Infection
- Malignancy
- PE
- Connective tissue diseases
5
Q
What are the signs/symptoms of pleural effusions?
A
- Asymptomatic – if small
- Breathlessness
- ↓ chest wall movement
- Stony dull percussion
- Absent breath sounds
- Reduced voice resonance
- Mediastinum shifted away
6
Q
What investigations are conducted for suspected pleural effusion?
A
- X-ray
- Dense shadow at bottom of lung
- Meniscus visible
- Diagnostic pleural fluid aspiration +/- US
- Colour is noted
- Milky = chylothorax
- Cloudy and thick = infection
- Microscopy and culture
- Protein, lactate, glucose, pH
- Contrast enhanced CT
- Pleural biopsy
7
Q
What are the surgical treatments for pleural effusions?
A
- Large volume throacocentesis
* Aspiration to dryness – in malignancy to stop reoccurance
8
Q
What are the pharmacological treatments for pleural effusion?
A
Transudate – manage underlying cause
