Pleural Effusions

Question 1

what is a pleural effusion?

Answer 1

an excessive accumulation of fluid in the pleural space

Question 2

symptoms of a pleural effusion?

Answer 2

• chest pain
• dry, non-productive cough
• dyspnoea/shortness of breath
• orthopnea (inability to breathe unless the patient is sitting up straight or standing erect)

Question 3

what are the 2 types of pleural effusion?

Answer 3

1) transudate pleural effusions

2) exudate plural effusions

Question 4

describe the protein content in transudate pleural effusions

Answer 4

= one that has a LOWER PROTEIN CONTENT.

protein < 30g/L

Question 5

what sort of problems cause transudate pleural effusion?

Answer 5

systemic problems

Examples;

• heart failure
• liver cirrhosis

Question 6

describe the protein content in exudate pleural effusion

Answer 6

= one that has a HIGHER PROTEIN CONTENT

protein > 30g/L

Question 7

what causes exudate pleural effusions?

Answer 7

• caused by pleural diseases.

Examples;

• malignancy
• infection, bacterial pneumonia
• pulmonary infarct

Question 8

how would you diagnose a pleural effusion?

Answer 8

1) chest X-ray
2) routine blood tests
3) aspiration of pleural fluid
4) cytology & cell counts

Question 9

what would a chest X-ray show?

Answer 9

• it is detected on X-ray when there is >300ml of fluid present.

Question 10

what 2 specific things would you test for in the blood test?

Answer 10

1) rheumatoid factor

2) tumour markers

Question 11

when you aspirate the pleural fluid what are you going to measure?

Answer 11

1) protein content
= transudate
= exudate

2) LDH
3) glucose concentration
4) pH

Question 12

when you are testing the pH from the pleural aspirate what does a pH < 7.3 suggest?

Answer 12

pH < 7.3

= suggests pleural inflammation

Question 13

when you are testing the pH from the pleural aspirate what does a pH < 7.2 suggest?

Answer 13

pH < 7.2

= requires drainage in the setting of infection

Question 14

what cells are you looking for during a cell count?

Answer 14

1) malignant cells
2) lymphocytes
3) neutrophils

Question 15

How would you treat a pleural effusion?

Answer 15

1) pleural drainage

= to remove a large quantity of fluid

Question 16

how would you treat a malignant pleural effusion that re-accumulates & is symptomatic?

Answer 16

• the fluid could be aspirated to dryness followed by instillation of a sclerosing agent e.g. tetracycline or talc

Question 17

why do you need to drain the fluid slowly from a pleural effusion?

Answer 17

since the rapid mediastinal shift causes severe pain & occasionally shock.