pleural effusion

Question 1

Causes of exudates

Answer 1

Exudates : affected permeability of the pleural surfaces and the capillaries around them 
usually unilateral 
protein fluid > 30g/l
Most common causes: 
-parapneumonic- E.G. pneumonia, Bronchiectasis 
-Malignancy 
Less common;
-PE
-rheumatoid arthyritis
-autoimmune disease
-post MI
-bening Pleural effusion
Rare: 
-yellow nail syndrome 
-Drugs

Question 2

Investigations

Answer 2

Chest radiograph (CXR: has to have at least 200ml in lungs )
Pleural aspiration: 

• Pleural biopsy:
• Pleural inspection: Thoracoscopy

Question 3

Signs

Answer 3

Stony dullness on percussion
Reduced chest expansion
Bronchial breathing
Reduced vocal resonance

also:

• finger clubbing
• increased JVP
• peripheral oedema
• lymphadenopathy
• tracheal deviation

Question 4

Symptoms

Answer 4

Could be asymptomatic if slowly developing 
Dry cough- Especially when it is building up quickly 
Pleuritic chest pain 
Increasing breathlessness 
Dull ache
Weight loss
Malaise
Fever

Question 5

pressures in the pleura

Answer 5

v: 1.5 kpa
P: 4kpa
overall negative intra-pleural

Question 6

Causes of transudates

Answer 6

Transudates: Due to imbalance of hydrostatic pressures-Decrease in osmotic pressure- more fluid moving out of the cells 
Increase in Hydrostatic- back flow of blood into the lungs leads to an increase in pressure 
bilateral 
protein fluid< 30 g/l
Most common:
-Left ventricular failure
-Liver cirrhosis 
-hypoalbunemia
-peritoneal dialysis- kidney damage 

Less common:

• hypothyrodism
• PE
• nephrotic syndrome-kidney damage
• mitral distress

Rare:

• restrictive pericarditis
• Ovarian hyperstimulation
• Meig’s syndrome

Question 7

What is Meig’s syndrome

Answer 7

• bening ovarian cancer
• ascites
• pleural effusion

Question 8

Definition

Answer 8

An abnormal collection of fluid in the pleural space of the lungs

Question 9

How treatment varies depending on the size of the pleural effusion

Answer 9

Small from heart failure: diuretics and Sodium restriction
Large from cancer: Draining with tube
Large from TB/Pneumonia: surgery

Question 10

Causes

Answer 10

• inflammation or malignancy chances the hydrostatic forces and the permeability of the capillaries leads to an increase in the secretion of fluid from the capillaries
• in some cases defaults in the lymphatic system can also lead to build up

Question 11

What is a chylothorax

Answer 11

Pleural effusion caused by a thoracic duct damage caused by surgery/ trauma

Question 12

Light’s criteria

Answer 12

Exudate if it scores more than 1

• If pleural fluid protein: serum protein >0.5
• If pleural fluid lipid: serum lipid >0.6
• If Pleural fluid LDG >2/3 of the upper limit of LDH in the serum