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Flashcards in Pleural Effusion Deck (24)
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1

What is a pleural effusion?

Fluid in the pleural space

2

What can make up the fluid?

Blood
Pus
Fluid
Chyle

3

What is blood in the pleural space called?

Haemothorax

4

What is pus in the pleural space called?

Empyema

5

What is chyle in the pleural space called?

Chylothorax

6

What is chyle?

Fluid made of fat and lymph suspended in chylomicrons

7

What causes chylothorax?

Fistula formation between lymphatic system and pleural space cause by inflammation

8

What are the classifications of pleural effusions?

Transdate
Exudate

9

What is a transudate?

Extravascular fluid with low protein content

10

What causes production of a transudate?

Disruption of oncotic forces

11

What is the pattern of a transudate pleural effusion?

Usually bilateral

12

What can cause a transudate pleural effusion?

Heart failure
Cirrhosis
Hypoalbuminaemia
Renal failure
SVC obstruction
PE
Meig's syndrome

13

What is Meig's syndrome?

Triad of pleural effusion, ascites and an ovarian fibroma

14

What is an exudate?

Extravascular fluid with high protein content

15

What causes production of an exudate?

Increased permeability secondary to inflammation

16

What is the pattern of an exudate pleural effusion?

Usually unilateral

17

What can cause an exudate pleural effusion?

Pneumonia
TB
Malignancy
Autoimmune
Dressler's syndrome

18

What is Dressler's syndrome?

Pericarditis occurring 2 weeks after an MI

19

How do you differentiate between a transudate and exudate?

Look at protein content of aspirate

Exudate = >35 g/L
Transudate = <25g/L

25-35 use Light's criteria

20

What is Light's criteria?

Uses serum protein and LDH

Exudate if
- effusion:serum protein >0.5
- effusion:serum LDH >0.6
- effusion LDh > 2/3 upper limit of normal

21

How do you investigate a pleural effusion?

ECG
Sputum culture
Urine dip

Bloods
- FBC
- U+Es
- CRP
- LFTs
- D-dimer
- Troponin
- autoantibody screen

CXR
Chest CT

Aspirate

22

What do you look for in the aspirate?

pH
Glucose
Cytology (RBCs, WBCs, malignancy)
Proteins

23

How do you manage a pleural effusion?

Treat underlying cause

Drain

Pleurodesis

24

What is pleurodesis?

Irritation of visceral and parietal pleura so they stick together

Use
- tetracycline
- talc
- bleomycin