Pleural Effusion

Question 1

What is pleural effusion?

Answer 1

Accumulation of fluid in pleural cavity.

Question 2

Examination signs for pleural effusion?

Answer 2

Stony dullness (percussion), Reduced breath sounds, Decreased vocal fremitus (patient says ‘99’, my hands on back) + Tracheal Deviation (large effusion)

Question 3

Investigating Suspected pleural effusion?

Answer 3

1) CXR - tracheal deviation, fluid in lung spaces + costophrenic blunting.
2) Pleural Tap - get fluid sample
3) Light’s criteria - classification

Question 4

What is a transudate effusion?

Answer 4

Pleural effusion due to SYSTEMIC causes -
Increased hydrostatic/decreased oncotic pressure.
Low protein + LDH

Question 5

What is a exudate effusion?

Answer 5

Pleural effusion due to LOCAL causes -
Inflammation/Capillary permeability
High Protein + LDH

Question 6

What is Light’s criteria?

Answer 6

Pleural : Serum Protein > 0.5
Pleural : Serum LDH >0.6
Pleural fluid LDH >2/3rds upper limit of normal
≥ 1 fulfilled = Exudate

Question 7

Management of Pleural Effusion.

Answer 7

1) Treat the underlying cause
2) Assess size/severity (symptomatic)
3) Conservative if small
3. 5) Chest Drain (symptomatic), Recurrent = Pleurodesis (sealing of pleural activity)