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Questions and Answers
What happens to the pleural effusion when there is an increase in hydrostatic pressure?
What happens to the pleural effusion when there is an increase in hydrostatic pressure?
Which characteristic distinguishes transudative effusions from exudative effusions?
Which characteristic distinguishes transudative effusions from exudative effusions?
Which sign is typically associated with pleural effusion during clinical examination?
Which sign is typically associated with pleural effusion during clinical examination?
What is the rationale behind performing a pleural fluid sampling?
What is the rationale behind performing a pleural fluid sampling?
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What clinical symptom is most commonly reported by patients experiencing pleural effusion?
What clinical symptom is most commonly reported by patients experiencing pleural effusion?
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In pleural effusion, which diagnostic method is best for visualizing the fluid accumulation?
In pleural effusion, which diagnostic method is best for visualizing the fluid accumulation?
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Which of the following conditions is not typically a cause of exudative effusion?
Which of the following conditions is not typically a cause of exudative effusion?
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Which underlying cause might lead to an increased capillary permeability resulting in pleural effusion?
Which underlying cause might lead to an increased capillary permeability resulting in pleural effusion?
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Study Notes
Pleural Effusion
- Pleural space typically contains 10-20 ml of serous fluid
- Secreted from capillaries of the parietal pleura
- Reabsorbed by capillaries of visceral pleura and lymphatics
- Imbalance between secretion and reabsorption leads to fluid accumulation in pleural space, causing pleural effusion
Types of Effusion
-
Transudative: Low protein content
- Increased hydrostatic pressure
- Decreased oncotic pressure
-
Exudative: High protein content
- Increased capillary permeability
Transudative Effusion Causes
-
Common:
- Left ventricular failure (LVF)
- Atelectasis
- Cirrhosis (hepatic hydrothorax)
- Hypoalbuminemia
- Peritoneal dialysis
- Pulmonary embolism (PE)
- Nephrotic syndrome
-
Less Common:
- Constrictive pericarditis
- Hypothyroidism
- Malignancy
- Meigs' syndrome
- Mitral stenosis
- Urinothorax
Exudative Effusion Causes
-
Common:
- Simple parapneumonic effusion (SPPE)
- Malignancy
- Tuberculosis (TB)
-
Less Common:
- Complicated parapneumonic effusion (CPPE)/empyema
- Other infections (viral, parasitic, rickettsial, fungal)
Clinical Presentation
-
History:
- Dyspnea
- Cough
- Chest pain
- Symptoms of underlying cause
-
Examination:
- Decreased or absent tactile fremitus
- Dullness to percussion
- Absent or decreased breath sounds
- Signs of underlying cause
Light's Criteria/Modified Light's Criteria
- Pleural fluid protein/serum protein ratio > 0.5
- Pleural fluid LDH/serum LDH ratio > 0.6
- Pleural fluid LDH > two-thirds the upper limit of normal serum LDH
Pleural Fluid Analysis: Glucose (LOW)
- Pleural fluid glucose <60 mg/dL: Four potential disorders
- Parapneumonic effusion (infection)
- Malignancy
- Rheumatoid disease
- Tuberculosis (TB)
Pleural Fluid Analysis: Albumin Gradient
- Formula: (Pleural Fluid Albumin - Serum Albumin)
- Interpretation:
- ≤1.2 g/dL: likely exudative effusion
-
1.2 g/dL: likely transudative effusion
- Gradient more specific in chronic heart failure (CHF), especially with postdiuresis
-
3.1 g/dL: very likely CHF
Investigations
- CXR
- US thorax
- CT chest
- Pleural fluid sampling (cytology, microbiology, biochemistry)
- Thoracoscopy/pleural biopsy
Treatment
- Small effusions: Observation
- Large or symptomatic effusions:
- Treat underlying cause
- Therapeutic thoracentesis (removal of 1-1.5 L fluid)
- Chest tube insertion
- Chest tube insertion + pleurodesis
- Indwelling pleural catheter
- Surgery
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Description
This quiz covers the key concepts of pleural effusion, including its normal physiology, types, and common causes. Learn about the distinctions between transudative and exudative effusions, as well as the conditions leading to each type. Perfect for students studying respiratory physiology or internal medicine.
