Podcast
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?
- Protein content of fluid becomes lower
- Fluid is reabsorbed faster than it is secreted
- Capillary permeability decreases
- Fluid accumulates in the pleural space (correct)
Which characteristic distinguishes transudative effusions from exudative effusions?
Which characteristic distinguishes transudative effusions from exudative effusions?
- Presence of high protein levels
- Increased capillary permeability
- Presence of infectious organisms
- Low protein levels (correct)
Which sign is typically associated with pleural effusion during clinical examination?
Which sign is typically associated with pleural effusion during clinical examination?
- Sharp chest pain on inspiration
- Hyperresonance on percussion
- Increased tactile fremitus
- Decreased or absent breath sounds (correct)
What is the rationale behind performing a pleural fluid sampling?
What is the rationale behind performing a pleural fluid sampling?
What clinical symptom is most commonly reported by patients experiencing pleural effusion?
What clinical symptom is most commonly reported by patients experiencing pleural effusion?
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?
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?
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?
Flashcards
Pleural space
Pleural space
The space between the parietal and visceral pleura, normally containing 10-20ml of serous fluid.
Pleural effusion
Pleural effusion
A buildup of fluid in the pleural space.
Transudative effusion
Transudative effusion
Fluid with a low protein content, often caused by increased hydrostatic pressure or decreased oncotic pressure. It's like a 'thin' fluid.
Exudative effusion
Exudative effusion
Signup and view all the flashcards
Increased hydrostatic pressure
Increased hydrostatic pressure
Signup and view all the flashcards
Decreased oncotic pressure
Decreased oncotic pressure
Signup and view all the flashcards
Increased capillary permeability
Increased capillary permeability
Signup and view all the flashcards
Chest X-ray (CXR)
Chest X-ray (CXR)
Signup and view all the flashcards
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
Studying That Suits You
Use AI to generate personalized quizzes and flashcards to suit your learning preferences.
