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    Pleural Effusions: Kara Lee Gallagher USC School of Medicine

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    Anas Yahya
    This document defines and discusses pleural effusions, which is excess fluid in the pleural cavity between the lungs and chest wall. It covers the epidemiology, pathophysiology, clinical presentation, diagnostic workup and treatment. Pleural effusions are classified as transudates or exudates based on fluid analysis. The workup involves thoracentesis, fluid analysis, imaging studies and determining the underlying cause. Treatment focuses on addressing the cause and draining excess fluid if needed.

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    Pleural Effusions: Kara Lee Gallagher USC School of Medicine

    Uploaded by

    Anas Yahya
    33 views20 pages
    This document defines and discusses pleural effusions, which is excess fluid in the pleural cavity between the lungs and chest wall. It covers the epidemiology, pathophysiology, clinical presentation, diagnostic workup and treatment. Pleural effusions are classified as transudates or exudates based on fluid analysis. The workup involves thoracentesis, fluid analysis, imaging studies and determining the underlying cause. Treatment focuses on addressing the cause and draining excess fluid if needed.

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    Pleural Effusions

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    This document defines and discusses pleural effusions, which is excess fluid in the pleural cavity between the lungs and chest wall. It covers the epidemiology, pathophysiology, clinical presentation, diagnostic workup and treatment. Pleural effusions are classified as transudates or exudates based on fluid analysis. The workup involves thoracentesis, fluid analysis, imaging studies and determining the underlying cause. Treatment focuses on addressing the cause and draining excess fluid if needed.

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    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    33 views20 pages

    Pleural Effusions: Kara Lee Gallagher USC School of Medicine

    Uploaded by

    Anas Yahya
    This document defines and discusses pleural effusions, which is excess fluid in the pleural cavity between the lungs and chest wall. It covers the epidemiology, pathophysiology, clinical presentation, diagnostic workup and treatment. Pleural effusions are classified as transudates or exudates based on fluid analysis. The workup involves thoracentesis, fluid analysis, imaging studies and determining the underlying cause. Treatment focuses on addressing the cause and draining excess fluid if needed.

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    Pleural Effusions

    Kara Lee Gallagher


    USC School of Medicine
    Definition
    Increased amount of fluid within the pleural
    cavity
    Stedmans Medical Dictionary
    Accumulation of fluid between the layers of
    the membrane that lines the lungs and the
    chest cavity
    Medline Plus

    Epidemiology
    United States
    1 million cases annually
    Internationally
    320/100,000 in industrialized countries
    Pathophysiology
    Normal: 1 mL of pleural fluid
    Balance between hydrostatic/oncotic forces and
    lymphatic drainage
    Abnormal: Pleural effusion
    Disruption of balance
    Clinical History
    Dyspnea
    Chest pain
    Physical Exam
    Decreased breath sounds
    Dullness to percussion
    Decreased tactile fremitus
    Egophony
    Pleural friction rub
    Types
    Hydrothorax
    Hemothorax
    Chylothorax
    Pyothorax or Empyema
    Classification
    Transudate
    Ultrafiltrate of plasma
    Small group of etiologies
    Exudate
    Produced by host of inflammatory conditions
    Large group of etiologies
    Workup: Thoracentesis
    Lights criteria: Transudate vs. Exudate
    Pleural fluid protein / serum protein > 0.5
    Pleural fluid LDH / serum LDH > 0.6
    Pleural fluid LDH >
    2
    /
    3
    ULN serum LDH



    Workup: Thoracentesis
    Other criteria: Transudate vs. Exudate
    Pleural fluid LDH > 0.45 ULN serum LDH
    Pleural fluid cholesterol > 45 mg/dL
    Pleural fluid protein > 2.9 g/dL
    Workup: Laboratory
    LDH > 1000 IU/L
    Empyema, Malignancy, Rheumatoid
    Glucose < 30 mg/dL
    Empyema, Rheumatoid
    Glucose between 30 50 mg/dL
    Lupus, Malignancy, TB

    Workup: Laboratory
    Lymphocytes > 85%
    Chylothorax, Lymphoma, Rheumatoid, TB
    Lymphocytes between 50 70%
    Malignancy
    Mesothelial cells > 5%
    TB unlikely
    ADA > 43 U/mL
    Supports TB
    Workup: Imaging
    Upright Chest X-Ray
    Blunting of costophrenic angles
    Supine Chest X-Ray
    Increased density over lower lung fields
    Lateral decubitus Chest X-Ray
    Layering

    Workup: Imaging
    Workup: Imaging
    Workup: Imaging
    Ultrasound
    Aids in identification of loculated effusions
    Aids in differentiation of fluid from fibrosis
    Aids in identification of thoracentesis site
    Available at bedside


    Workup: Imaging
    CT Scan
    Aids in differentiation of
    Lung consolidation vs. Pleural effusion
    Cystic vs. Solid lesions
    Peripheral lung abscess vs. Loculated emypema
    Aids in identification of
    Necrotic areas
    Pleural thickening, nodules, masses
    Extent of tumor
    Work up: Imaging
    Treatment
    Treat underlying etiology
    Therapeutic thoracentesis
    Questions?
    Image sources cited in notes

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