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Flashcards in Pleural Effusion Deck (22)
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1
Q

What are the two types of pleural effusions?

What are some examples which may cause each?

A

Transudative: Decrease in osmotic pressure
Cirrhosis
CHF
Nephrotic Syndrome

Exudative:  Increased inflammation and increased capillary permeability
Malignancy
PE
Infection (Bacterial Pneumonia or TB)
Chylothorax
2
Q

There is a BILATERAL pleural effusion visible on CXR; this suggests which clinical conditions?

A

CHF
Renal Failure
Fluid overload
(TRANSUDATIVE – BILATERAL) TRAN’nies are BOTH genders

3
Q

There is a UNILATERAL pleural effusion present on CXR. What would remain at the top of your differential after observing this finding?

A
Malignancy
Trauma
Infection
Chylothrorax
(EXUDATIVE -- UNILATERAL)
4
Q

T/F

Transudative effusions rarely require further interventions.

A

True
No extensive intervention usually necessary

May require drainage (thoracentesis) however if too much fluid build up

5
Q

Fluid is drained during a thoracentesis of suspected pleural effusion. It is clear in color which leads you to suspect it is which type?

A

Transudative (effusion is clear in color once drained)

Exudative would have been yellowish-brown more infectious in nature

6
Q

What is Light’s Criteria utilized for?

What are the criteria?

A

Determining Exudate v. Transudate

EXUDATE IF 1 of the following!

  1. Pleural fluid protein / serum protein > 0.5
  2. Pleural fluid LDH / serum LDH > 0.6
  3. Pleural fluid LDH > 2/3 of the normal upper limit for LDH

Since increased inflammation (and/or infxn) is the hallmark cause of EXUDATIVE effusions…

Increased protein and LDH would make sense because inflammatory cytokines are protein in nature and the LDH enzymes would will follow for energy production at the site of inflam. modulation.

7
Q

What UTI medication can cause a pleural effusion?

A

Nitrofurantoin

8
Q

What is the clinical presentation of a pleural effusion?

A

SOB
Pleuritic Px w/ cough
Dyspnea on exertion
Orthopnea

DECREASED TACTILE FREMITUS
(decreased because the effusion is located in the pleural space and acts as a barrier between lung sounds and the exterior body)

Dullness to percussion
Egophony
Decreased breath sounds
Friction Rub
Mediastinal shift away form unilateral effusion
9
Q

A CXR was ordered for a PT with a suspected pleural effusion. What findings could you expect on the CXR?

A

ONLY VISIBLE if >200mL
Blunted costophrenic angles
Mediastinal shift away from affected side (only in unilateral (Exudative) effusions)

10
Q

A thoracostomy tube is about to be placed or a thoracentesis is about to be performed; what imaging study should you order to ensure its proper insertion into the effusion?

A

Ultrasound

11
Q

When would a CT scan for a pleural effusion be indicated?

A

Small effusions; that are complicated paraneumonic or possible empyema

12
Q

After fluid is drawn from a pleural effusion during a thoracentesis; what labs would you want ordered on the fluid?

A
CBC w/ diff
Protein and LDH
BNP (to r/o cardiac CHF in origin)
Gram and Acid Fast Bacillus
Culture and sensitivity for bacteriology, cytology, and virology 

(if malignancy suspected send 3 different samples to ensure malig. is not missed!)

13
Q

The fluid pulled from an effusion appears milky in color; what might this be associated with?

A

Infectious discharge/pus –> CHYLOTHORAX

Triglycerides in lipid panel will be through roof (>110mg/dL) “obstructed thoracic duct”

14
Q

Frank bloody fluid is pulled from an effusion; what remains at the top of your differential?

A

Malignancy (order glucose; b/c will be low because cancerous cells are using it at such a high rate to proliferate)

Pulmonary Emboli w/ associated INFARCT

Trauma

Post cardiac injury syndrome

15
Q

Purulent fluid in removed pleural fluid would indicate an…

A

EMPYEMA

pH <7, glucose, cultures should be ordered

16
Q

pH of fluid may be below 7.3 in which conditions?

A

Malignancy
Parapneumonic effusion
Infection (empyema) (<7.0 in this)

17
Q

Since you usually would perform a thoracentesis; when would you order a Chest Tube Thoracostomy for your PT?

A

Hemothorax
Cancer
Severe infection (empyema)
Drainage will need to be performed for several days

18
Q

When would a Pleurodesis be indicated?

What agents could you use in Pleurodesis?

A
Recurrent effusions (malig or CHF)  
     The pleurodesis is performed after drainage; and the inflammatory reaction causes fibrotic readhesion of pleura to chest wall

Doxy
Bleomycin sulfate
Talc

19
Q

What are some potential complications of a Thoracentesis you should advise you patients about?

A
10% risk Pneumothorax
Infxn (always risk inserting FB)
Hemothorax
Vasovagal reaction (low BP, low HR)
Pulmonary Edema (if >1 to 1.5L drawn)
20
Q

Purulent fluid is drawn from a Pleural effusion. What labs should you order?

A

Empyema

pH
Glucose
Cultures

21
Q

Malignancy will have what labs support your Dx?

A

Pos. Cytology

< fluid glucose <60mg/dL

22
Q

Serous fluid is like what kind of effusion?

What are some of the most common causes?

A

TRANSUDATIVE

CHF
Fluid overload
Renal Dz
Cirrhosis