Pleural effusion

• How are pleural effusions classified?

  Transudate

  Exudate
• How can you tell the difference between transudate or exudate pleural effusions?

  Protein concentration
• What is the protein concentration for transudate pleural effusion?

  < 30g/L protein
• What is the protein concentration for exudate pleural effusion?

  > 30g/L protein
• What is the most common cause of transudate pleural effusion?

  Congestive heart failure
• What are some causes of transudate pleural effusion?

  Heart failure

  Hypoalbuminaemia

  Hypothyroidism

  Meigs' syndrome
• What is the most common cause of exudate pleural effusions?

  Pneumonia
• What are some causes of exudate pleural effusion?

  Infection - pneumonia, TB, subphrenic abscess

  Connective tissue disease

  Neoplasia

  Pancreatitis

  PE

  Dressler's syndrome

  Yellow nail syndrome
• What are some signs and symptoms of pleural effusion?

  Dyspnoea

  Non-productive cough

  Chest pain
• What are some classic examination findings for pleural effusion?

  Dullness to percussion

  Dec breath sounds

  Dec chest expansion
• What is done to investigate pleural effusion?

  PA chest x-ray

  Ultrasound - pleural aspiration and sensitive for detecting pleural fluid septations

  Pleural aspiration

  Contrast CT
• What is Light's criteria?

  Distinguish between transudate and exudate
• When does the BTS recommend using Light's criteria?

  Borderline cases
• What could it mean if there is low glucose in the pleural fluid?

  RA

  TB
• What could it mean if there is raised amylase in the pleural fluid?

  Pancreatitis

  Oesophageal perf
• What could it mean if there is heavy blood staining in the pleural fluid?

  Mesothelioma

  PE

  TB
• How are pleural effusions managed?

  Aspiration

  Pleurodesis

  Indwelling pleural catheter

  Symptom management with drugs