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 ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download