Pleural Effusion

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Pleural Effusion

History

• shortness of breath

• pleuritic pain

Examination

• introduction, exposure

• Observation

  • chest movement reduced / absent on affected side

  • cachexia / weightloss

  • radiotherapy marks

  • scars

    • mastectomy

    • aspiration

• Hands

  • Clubbing

  • Tar stains

  • Rheumatoid arthritis

• Face

  • cyanosis

  • butterfly rash of Systemic Lupus Erythematosus

• Neck

  • Lymphadenopathy

  • Trachea deviated away from large effusions / towards collapse

• Chest

  • Exapansion

    • reduced on affected side

  • Tactile Vocal Fremitus

    • decreased 

  • percussion

    • stony dull

  • auscultation

    • vocal resonance reduced / absent

    • breath sounds reduced / absent

    • bronchial breathing / aegophony at upper limit

    • ? pleural rub

• Extras

  • TB (Asian)

  • Temperature chart

  • Sputum Pot

  • Ankle 

    • oedema = Heart Failure

    • DVT = Pulmonary Embolism

Causes

Exudates

• Common
  • Pulmonary infarct / Pulmonary Embolism

  • Pneumonia

  • Tuberculosis

  • tumour

  • sub-diaphragmatic disorders

    • abscess

    • Acute Pancreatitis

  • connective tissue disease

    • Systemic Lupus Erythematosus

    • Rheumatoid arthritis

• uncommon
• acute Rheumatic Fever
• post-MI syndrome
• uraemia
• asbestos-related disease
  • mesothelioma
• yellow-nail syndrome
• myxoedema / Hypothyroidism
• Meig's syndrome

Transudates

• Common
  • Heart Failure
  • hypoproteinaemia
    • Nephrotic Syndrome
  • Cirrhosis

Investigations

• CXR
• USS
• Sputum
  • cytology
  • MC&S
• Pleural aspirate
  • cytology
  • MC&S
  • AFBs
  • Biochemistry
    • LDH
    • Protein
    • Amylase
    • Glucose
• Pleural Biopsy
• Bronchoscopy
• CT
• V/Q scan

Management

• aspirate / drain
• treat underlying cause
• pleurodesis
  • tetracycline
  • talc

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