Pleural Effusion

• What is a pleural effusion?

  A pleural effusion is a collection of fluid in the pleural space.
• How can pleural effusions be categorized?

  • Exudative: high protein content (more than 30g/L)
  • Transudative: lower protein content (less than 30g/L)
• What are Light's criteria used for?

  Light's criteria are used for establishing an exudative effusion using protein or lactate dehydrogenase (LDH).
• What is the first criterion of Light's criteria?

  Pleural fluid protein/serum protein greater than 0.5.
• What is the second criterion of Light's criteria?

  Pleural fluid LDH/serum LDH greater than 0.6.
• What is the third criterion of Light's criteria?

  Pleural fluid LDH greater than 2/3 of the normal upper limit of the serum LDH.
• What are the main causes of exudative pleural effusions?

  • Cancer (e.g., lung cancer or mesothelioma)
  • Infection (e.g., pneumonia or tuberculosis)
  • Rheumatoid arthritis
• What are the main causes of transudative pleural effusions?

  • Congestive cardiac failure
  • Hypoalbuminaemia
  • Hypothyroidism
  • Meigs syndrome
• What is Meigs syndrome?

  Meigs syndrome involves a triad of a benign ovarian tumour, pleural effusion, and ascites.
• What is the typical presenting symptom of pleural effusion?

  The typical presenting symptom is shortness of breath.
• What are the examination findings for pleural effusion?

  • Dullness to percussion over the effusion
  • Reduced breath sounds
  • Tracheal deviation away from the effusion in very large effusions
• What are the chest x-ray findings for pleural effusion?

  • Blunting of the costophrenic angle
  • Fluid in the lung fissures
  • Larger effusions will have a meniscus
  • Tracheal and mediastinal deviation away from the effusion in very large effusions
• How do ultrasound and CT scans compare to chest x-rays in detecting pleural effusions?

  Ultrasound and CT can detect smaller effusions than a chest x-ray, estimate the volume, and identify potential causes.
• What is required for pleural fluid analysis?

  Pleural fluid analysis requires a sample taken by aspiration or chest drain.
• What does pleural fluid analysis help establish?

  Pleural fluid analysis helps establish the underlying cause by measuring protein content, LDH, cell count, pH, glucose, and microbiology testing.
• What is the mainstay of management for pleural effusion?

  • Diagnosing and treating the underlying cause
  • Conservative management for small effusions
  • Aspiration or drainage for significant effusions
• What does pleural aspiration involve?

  Pleural aspiration involves sticking a needle through the chest wall into the effusion and aspirating the fluid.
• What is the purpose of pleural aspiration?

  Pleural aspiration can temporarily relieve the pressure, but the effusion may recur, and further drainage may be required.
• What is a chest drain used for?

  A chest drain is used to drain the effusion and prevent it from recurring.
• What is empyema?

  • Empyema refers to an infected pleural effusion.
  • Suspect empyema in a patient with improving pneumonia but a new or ongoing fever.
• What are the findings in pleural aspiration for empyema?

  Pleural aspiration shows pus, low pH, low glucose, and high LDH.
• How is empyema treated?

  Empyema is treated with a chest drain and antibiotics.
• What resources are available for testing knowledge on pleural effusions?

  • Digital Flashcards
  • Anki-like Fact Trainer
  • Short Answer Questions
  • Multiple Choice Questions
  • Extended Matching Questions
  • Revision Tracking Tool
  • OSCE Practice Tool