Pleural effusion - Revision history

Aidan at 17:34, 30 July 2020

2020-07-30T17:34:40Z

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 *[[Asbestosis]]
 *'''Light's Criteria'''
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 **TB
 **Rheumatoid arthritis (especially when &lt;1.6)
 [[Category:Respirology]]

Aidan: /* Differential Diagnosis */ linkified

2020-07-30T17:33:48Z

Differential Diagnosis: linkified

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Aidan: Text replacement - "Clinical Presentation" to "Clinical Manifestations"

2020-07-14T23:25:42Z

Text replacement - "Clinical Presentation" to "Clinical Manifestations"

← Older revision		Revision as of 23:25, 14 July 2020
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	** Rheumatoid arthritis (especially when <1.6)		** Rheumatoid arthritis (especially when <1.6)

	== Clinical ~~Presentation~~ ==		== Clinical Manifestations ==

	* History of CHF, cirrhosis, CKD, TB, malignancy		* History of CHF, cirrhosis, CKD, TB, malignancy

Maintenance script: Imported from text file

2020-07-04T01:17:51Z

Imported from text file

New page

== Etiology ==

* Increased influx from pleural vessels and decreased efflux via lymphatic system of pleural fluid

== Differential Diagnosis ==

* Transudative
** Congestive heart failure
*** Unless post-diuresis
** Cirrhosis
** Nephrotic syndrome
** Peritoneal dialysis
** Atelectasis
* Exudative
** Infection, including [[parapneumonic effusion]]
** Malignancy
** Connective tissue disorders
** Inflammatory disorders
** Movement of fluid from abdomen to pleural space
** CABG
** Pulmonary embolism
* Medication (check Pneumotox online)
** Methotrexate
** Amiodarone
** Nitrofurantoin
** Phenytoin
** Beta-blockers
* Asbestosis

== Fluid Analysis ==

* '''Light's Criteria'''
** Exudate is exudative if at least one of:
*** Pleural fluid to serum protein ratio > 0.5
*** Pleural fluid to serum lactate dehydrogenase (LD) ratio > 0.6
*** Pleural fluid LD level > 2/3 of upper limit of normal
**** ULN usually ~220, so LD > 148
* Modified Light's Criteria
** Protein >29
** LDH >0.45 times serum LDH
** Pleural cholesterol >1.165 mmol/L
* Also albumin gradient and BNP can help differentiate
* pH
** Normal: 7.60-7.64
** Exudate: 7.30-7.45
** Transudate: 7.40-7.55
** <7.2
*** Malignancy
*** Empyema (low glucose)
*** TB
*** Rheumatoid arthritis (especially if really low glucose)
* Glucose <3.3
** Malignancy
** Empyema
** TB
** Rheumatoid arthritis (especially when <1.6)

== Clinical Presentation ==

* History of CHF, cirrhosis, CKD, TB, malignancy
* Decreased lung sounds with dullness on percussion

== Investigations ==

* Labs
** Pleural fluid and serum protein and LDH
* Imaging
** CXR is first-line imaging
*** Blunting suggests at least 200mL of effusion
*** Lateral more sensitive (50mL)
*** Lateral decubitus is also helpful to rule out loculations
** Bedside ultrasound is best for internal medicine
*** More sensitive than CXR (3-5mL)
*** Better than CT for assessing the pleura
* Thoracentesis
** Risks
*** Pneumothorax <5%
*** Hemothorax 1%
**** Avoid if INR >3 or platelets <25
*** Re expansion pulmonary edema <1%
**** Avoid taking more than 1-2L
** Diagnostic requires 50mL (5-10 for microbiology, 2-5 for biochemistry, 20-40 for cytology)

[[Category:Respirology]]