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Flashcards in Pleural Effusion Deck (11):
1

What is pleural effusion? Different types?

Fluid in the pleural space

Exudate (>35g/L protein) or transudate (<25g/L protein)

Blood- haemothorax
Pus - empyema
Chyle (lymph with fat) - chylothorax
Blood and har - haemiopneumothroax

2

What causes transudate pleural effusions?

Increased venous pressure (cardiac failure, constrictive pericarditis, fluid overload)
Hypoproteinaemia (cirrhosis, nephrotic syndrom, malabsorption)
Hypothyroidism

3

What causes exudate pleural effusions?

Increased leakiness of pleural capillaries secondary to infection, inflammation or malignancy

Pneumonia
TB
Pulmonary infarction
RA
SLE
Bronchogenic carcinoma
Malignant metastases
Mesothelioma

4

What are symptoms of pleural effusion?

Asymptomatic or dyspnoea, pleuritic chest pain

5

What are signs of pleural effusion?

Decreased expansion
Stony dull percussion
Diminished breath sounds
On affected side

Tactile vocal fremitus and vocal resonance are reduced

Above effusion where lung is compressed, there may be bronchial breathing

Large effusions - tracheal deviation away from effusion

Signs of associated disease:
Malignancy (cachexia - weakness/wasting, clubbing, lymphadenopathy, chronic liver disease, cardiac failure, hypothyroidism, RA, SLE)

6

What might you see in a large pleural effusion?

Tracheal deviation away from affected side

7

What Ix for pleural effusion?

CXR:
Small - blunt costophrenic anglres
Large: water dense shadows with concave upper borders
Flat upper border implies there is also a pneumothorax

USS - identify presence of pleural fluid and guiding diagnostic or therapeutic aspiration

Diagnostic aspiration

Pleural biopsy if diagnostic aspiration analysis is inconclusive

8

What will you see on CXR? What if flat upper border?

Small - blunt costophrenic anglres
Large: water dense shadows with concave upper borders
Flat upper border implies there is also a pneumothorax

9

How do you perform a diagnostic aspiration of pleural effusion?

Percuss upper border of pleural effusion and go 1/2 intercostal spaces below it.
Infiltrate with 5-10ml 1% lignocaine
21G needle insert above upper border of rib (avoids neuromuscular bundle)
Draw off 10-30 ml and send to lab for clinical chemistry, bacteriology, cytology, immunology.

10

How do you manage pleural effusion?

Drainage:
If symptomatic drain repeatedly if necessary.
Remove fluid slowly
Empyema best drained with chest drain

11

Cause of clear/straw coloured effusion? Yellow, turbid effusion? Haemorrhagic effusion?
High neutrophils? High lymphocytes?

Clear/straw - transudate/exudate
turbid yellow - empyema/parapneumonic effusion
Haemorrhages - trauma, malignancy, pulmonary infarction.

Neutrophils - parapneumonic effusion/PE
Lymphocytes - malignancy, TB, RA, SLE, sarcoidsois