Pleural effusion
|Pleural effusion |
|Patho-physiology |Normal: formed at 100ml/day; ultrafiltrate of plasma |
| |Protein 2/3 upper limit of normal for serum LDH (82% sens, 90% spec) |
| |Pleural fluid chol >1.1, pleural fluid chol : serum chol >0.3, serum alb – pleural alb = >1.2 |
| | |
| |Causes: produced by inflamm conditions ( loss of semipermeable membrane Fx |
| |Ca (1Y lung 38%, breast 17%, lymphoma 12%, GI 7%, GU 9%, unknown 11%) |
| |75% are symptomatic |
| |if massive most likely Ca, PE (80%), TB, RA, sarcoidosis, SLE, Dresslers, asbestos, intraabdominal abscess |
| |if R sided (ascites, CCF, liver abscess) |
| |L sided (pancreatitis, ruptured oesophagus) |
| | |
| |Pneumonia: 50% pneumonia will have pleural effusions; initially sterile ( 1000 |
| | |
| |Drainage required if: pH of pleural fluid 1/3 hemithorax) |
| |sampling suggests empyema |
| |LDH >1000 |
| |pleural glu 25% |
| |Causes: trauma, iatrogenic |
| |Mng: place ICD ( do thoracotomy if >200ml/hr drained for >4-6hrs |
|Empyema |Definition: pus in thoracic cavity due to pleural space infection |
| |Pathophysiology: exudate; initially easy to drain ( becomes loculated within hrs ( fibrinopurulent exudate ( thick organised collections that|
| |require decortication (takes several weeks) |
| |Causes: pneumonia (strep pneumoniae (becoming more common in children), staph aureus (most common cause 250ml (40% sens, 85% spec); lateral is more sens than PA; 100ml may be detected on lat decubitus film; if|
| |meniscus absent = concurrent pneumothorax |
| |USS: more sens than CXR; 100% sens for >100ml, but can detect 5-50ml; can tell between pleural thickening and fluid; can guide procedures; |
| |can tell if loculated |
| |CT chest: shows underlying lung parenchyma; can tell empyema from lung abscess; more info about other structures |
|Mng |Needle thoracocentesis: |
| |Indications: diagnostic indicated if >1cm on USS or lat decubitus CXR with unknown cause; therapeutic indicated |
| |if RS/CV compromise, mediastinal shift, sometimes for Sx |
| |Technique: remove up to 1.5L (if larger than this, do at ................
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