Pleural effusion
| Incidental findings | Clubbing, radiation burns, aspiration marks, lymphadenopathy |
| +ve signs | Stony dull PN, ↓breath sounds, ↓vocal resonance |
| Differential diagnosis | Pleural effusion cause depends upon transudate or exudate |
| Function | ?respiratory compromise |
| Tests |
CXR, USS Pleural tap – protein, albumin, LDH, glucose, cyto, micro, AFB Pleural biopsy, CT chest |
Causes
|
Transudate Cardiac failure Nephrotic syndrome Cirrhosis |
Exudate Neoplastic: Ca bronchus / met / mesothelioma Infectious: Pneumonia, TB Connective tissue: RA, SLE PE |
Notes
- Protein > 30 = exudate, protein < 30 = transudate
- Lights criteria for exudate (i) pleural:serum protein > 0.5 (ii) pleural:serum LDH > 0.6 (iii) pleural LDH > ⅔ upper limit for serum LDH
- Serum:effusion albumin gradient 1.2g/dl very specific for exudate
- Can have area of bronchial breathing above dullness. c.f. Consolidation = bronchial breathing, increased vocal resonance; Collapse = trachea to side, absent breath sounds.
- Meigs = Ovarian tumour with R effusion (transudate)