Pleural Effusion
CAUSES – …just about anything!
- Blood – post-op, trauma, malignancy, pulmonary infarct
- Exudate – parapneumonic effusion, empyema, subphrenic abscess, pancreatitis
- Transudate – increased hydrostatic pressure (heart and liver failure, fluid overload), decreased oncotic pressure (nephrotic syndrome, loosing protein), negative pleural pressure (atelectasis)
- Chyle
CXR FINDINGS (supine)
< 500mL
- homogenous density over lower lung zone
- veil appearance to lung
- lung markings not obliterated
- air bronchograms absent
500-3000mL
- silhouetting of diaphragm
- contralateral mediastinal shift >3000mL
- opacification of hemithorax
- contralateral mediastinal shift
PLEURAL FLUID
Things to put on the lab form:
- Protein
- LDH
- Glucose
- pH
- WCC
- Cytology
- Amylase
- HCT
- Gram stain
- Culture
Appearance
- straw coloured: normal
- blood: trauma, malignancy, pulmonary infarct, post pericardiotomy
- turbid: parapneumonic effusion or empyema
Protein
- PF:serum < 0.5 = transudate – PF:serum > 0.5 = extudate
LDH
- PF:serum < 0.6 = transudate – PF:serum > 0.6 = extudate
Glucose
- if less than half of serum: empyema, malignancy, RA, SLE
pH
- < 7.3 = empyema
WCC
- neutrophilia: parapneumonic effusion, empyema, PE
- lymphocytosis: Tb, RA, SLE, sarcoid, malignancy
Cytology
- malignancy
- mesothelial cells increased: mesothelioma
- mutinucleating giant cells: RA
Other
- chyomicrons and triglycerides: chylothorax
- amylase (PF > serum): ruptured oesophagus, pancreatitis, malignancy, bacterial pneumonia
- HCT > 0.5: haemothorax
References and Links
- CCC – Pleural effusion
- CCC – Pleural tap
- CCC – Pleural fluid analysis
Critical Care
Compendium
Chris is an Intensivist and ECMO specialist at The Alfred ICU, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the Clinician Educator Incubator programme, and a CICM First Part Examiner.
He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.
His one great achievement is being the father of three amazing children.
On Bluesky, he is @precordialthump.bsky.social and on the site that Elon has screwed up, he is @precordialthump.
| INTENSIVE | RAGE | Resuscitology | SMACC