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    Pleural Effusion

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    Wan Hafiz
    Pleural effusions can be classified as transudates or exudates based on protein levels. Transudates have protein levels <25g/L while exudates are >35g/L. Common causes of transudates include heart failure and liver disease. Common causes of exudates include infection, malignancy, and inflammation. Pleural fluid analysis and Light's criteria can help distinguish between transudates and exudates. Management may involve drainage and pleurodesis to prevent recurrence.

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    Pleural Effusion

    Uploaded by

    Wan Hafiz
    215 views12 pages
    Pleural effusions can be classified as transudates or exudates based on protein levels. Transudates have protein levels <25g/L while exudates are >35g/L. Common causes of transudates include heart failure and liver disease. Common causes of exudates include infection, malignancy, and inflammation. Pleural fluid analysis and Light's criteria can help distinguish between transudates and exudates. Management may involve drainage and pleurodesis to prevent recurrence.

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    Pleural effusions can be classified as transudates or exudates based on protein levels. Transudates have protein levels <25g/L while exudates are >35g/L. Common causes of transudates include heart failure and liver disease. Common causes of exudates include infection, malignancy, and inflammation. Pleural fluid analysis and Light's criteria can help distinguish between transudates and exudates. Management may involve drainage and pleurodesis to prevent recurrence.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    215 views12 pages

    Pleural Effusion

    Uploaded by

    Wan Hafiz
    Pleural effusions can be classified as transudates or exudates based on protein levels. Transudates have protein levels <25g/L while exudates are >35g/L. Common causes of transudates include heart failure and liver disease. Common causes of exudates include infection, malignancy, and inflammation. Pleural fluid analysis and Light's criteria can help distinguish between transudates and exudates. Management may involve drainage and pleurodesis to prevent recurrence.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 12

    Pleural effusion

    Transudate : < 25g/L


    Exudate > 35g/L
    Blood: hemothorax, pus : empyema, lymph with fat : cylothorax, air
    and blood : heamopneumothorax
    causes
    Transudate , 25g/L
    CHF
    Constrictive pericarditis
    Fluid overload
    Hypoproteinaemia eg. Cirrhosis,
    nephrotic syndrome, malabsorption
    Hypothyroidism
    Meigs syndrome (rt PE with ovarian
    fibroma)

    Exudate > 35 g/L
    Infection : pneumonia, TB,
    Malignancy : bronchogenic ca,mets,
    lymphoma, mesothelioma
    Inflammation: SLE, RA
    Clinical features
    Dyspnoea
    Pleuritic chest pain
    Decrease chest expansion
    Stony dullness on percussion
    Diminished breath sound
    Tactile fremitus, VR are decrease or absent
    Bronchial breathing above the effusion
    Tracheal deviation to opposite side

    Other CF to look for
    Stigmata of chronic liver dz
    Malignancy*/ TB : cachexia, clubbing, Lymphadenopathy, mastectomy
    scar*, radiations mark*
    Cardiac failure
    Hypothyroidism
    Rheumatoid arthritis
    Butterfly rash in SLE
    Ix
    CXR :blunt costophrenic angle, dense shadows with concave upper
    border (meniscus sign). Detected PE if volume more than 250ml/
    300ml
    Ultrasound: site for pleural tap
    Pleural fluid analysis
    Pleural biopsy ( if pleural fluid analysis is inconclusive or clinical
    suspicion of malignancy or TB)
    Where to do tapping?
    Percussed upper border of the effusion
    Tap 1-2 intercostal below it.
    Infiltrate pleural with 5-10mL 1% of lidocaine
    Attached a 21G and insert it just upper border of the ribs ( lower
    border has the neurovascular bundles)
    Draw 10-30mL of the pleural fluid and send to lab for the
    biochemistry (protein, glucose, pH, LDH, amylase) , bacteriology (TB
    culture, microscopy ad stain, auramine stain), cytology, immunology
    (RF, ANA, complement)
    Pleural fluid analysis
    Gross appearances:
    Clear, straw colored: transudate, exudate
    Turbid, yellow: empyema, parapneumonic effusion
    Hemorrhagic: pulmonary infarction, trauma
    Cytology
    Neutrophils ++ : parapneumonic effusion, PE
    Lymphocytes ++ : malignancy, TB, RA, SLE, sarcoidosis
    Multinucleated giant cells: RA
    Lupus erythematosus cells: SLE

    Clinical chemistry
    Protein : <25 g/L transudate; > 35 exudate, 25-35 g/L if pleural fluid
    proteins/serum protein > 0.5 the effusion is exudate
    Glucose: < 3.3mmol/L : Empyema, malignancy, TB, RA, SLE
    pH <7.2 : Empyema, malignancy, TB, RA, SLE
    LDH high (pleural: serum > 0.6): Empyema, malignancy, TB, RA, SLE
    Amylase high: pancreatitis, Ca, esophageal rupture
    Immunology
    RF: RA
    Antinuclear AB: SLE
    Complement low: RA, SLE, malignancy, infections

    Lights criteria
    To distinguish pleural transudate from exudate

    Pleural fluid is exudate if one or more criteria are met:
    Pleural fluid protein: serum protein > 0.5
    Pleural fluid ldh: serum ldh ratio > 0.6
    Pleural fluid ldh> 2/3 UL of normal serum ldh

    Mx
    Drainage by pleural tap or intercostal drain (chest tube). Removed
    slowly (<2L/24h). CX: Pneumothorax
    Pleurodesis: tetracycline, bleomycin, talc
    Surgery: remove one pleural so they can stick with chest wall
    Case Presentations

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