Pulm-Pleural Effusion

Question 1

Pleural Effusion

Answer 1

Path: Transudate: “fluid”
- increased hydrostatic = CHF
- decreased oncotic = cirrhosis, nephrosis
Exudate: “stuff”
- increased permeability = TB, Cancer, Pna

Pt: Exertional dyspnea, orthopnea, incidentally found on X-ray

Dx: 1st CXR
Then decubitus CXR (or ultrasound)
Then: thoracentesis (not loculated) 
OR thoracostomy (loculated) 
OR thoracotomy (empyema)
Best: Biopsy, Gram Stain, Cytology

Tx: If CHF, do NOT tap, just diuresis
If no CHF, tap, then treat accordingly to the underlying diagnosis

Question 2

Thoraprocedures

Answer 2

Thoracentesis - Needle in the chest

Thoracostomy - Chest tube in the chest

Thoracotomy - Hole cut in the chest

Question 3

Lights Criteria

Answer 3

LDH greater than 200

LDHfluid: LDH serum greater than 0.6

TPfluid: TPserum greater than 0.5

Any ONE signifies an exudate

Question 4

Fluid Workup

Answer 4

Cell count w differential - infxn

Gram stain - infxn

Culture - infxn

AFB smear - TB

Adenosine Deaminase - TB

Cytology - Cancer

TP - Lights

LDH - Lights

RBC - Hemothorax

Amylase - Chylothorax

pH, Glucose - Other