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12 Cards in this Set
- Front
- Back
- 3rd side (hint)
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Volume of fluid accumulation necessary to become clinically evident in pleural effustion - detectable on x-ray |
500ml - 200ml |
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Clinical features of pleural effusion |
- dyspnoea - pleuritic chest pain - tracheal deviation: away from effusion - decreased chest wall expansion - stony dullness on percussion - decreased air entry - bronchial breathing: above effusion |
7 |
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CXR in pleural effusion |
- blunting of the costophrenic angles - dense shadows with a meniscus - mediastinal shift away |
3 |
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Diagnosis of pleural effusion (4+6) |
US-guided pleural aspiration/biopsy - colour - biochemistry (LDH, protein, pH, glucose, triglycerides, amylase) - cytology - culture & gram stain: auramine stain, TB culture - immunology: ANA, complement |
5 (2:6) |
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Light's criteria |
Exudate - pleural fluid protein: serum protein ratio >0.5 - pleural fluid LDH: serum LDH ratio > 0.6 - pleural fluid LDH > 2/3 ULN serum LDH |
3 |
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Transudate - pathophysiology - contents |
- increased hydrostatic pressure, decreased oncotic pressure - protein < 30g/l, LDH < 200IU/l |
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Causes of transudates |
- HF (90%) - constrictive pericarditis - hypoproteinaemia (liver failure, nephrotic syndrome, malnutrition) - hypothyroidism - uncommon: Meig's syndrome (ovarian tumour) |
5 |
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Exudate - pathophysiology - contents |
- increased vascular injury (inflammation/injury) - protein > 30g/l, LDH > 200IU/l |
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Causes of exudate |
- infection: bacterial pneumonia, TB - inflammation: acute pancreatitis - infarction: PE - malignancy: carcinoma of the bronchus, mesothelioma, lymphoma - uncommon: connective tissue disorders (SLE, RA), myxoedema |
5 |
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Management of pleural effusion - complications |
Thoracocentesis, aka pleural tap - re-expansion pulmonary oedema (1.5l at first, then 1l every 8hrs) |
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Parapneumonic effusions types |
- uncomplicated: sterile pleural fluid, normal pH & glucose, treated with ABx - complicated: bacteria, low pH & glucose, chest drain ABx - empyema |
3 |
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Empyema - types - clinical features (8) - investigation - management |
- single collection, loculated - persistent/recurrent pyrexia, rigors, sweating, malaise, weight loss, pleural pain, dyspnoea, productive cough - US/CT - large intercostal tube, ABx for 2-4wks |
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