Pleural effusion

Transudates:

can be bilateral, but are often larger on the right side.

The protein content is less than 30 g/L and the LDH is less than 200 IU/L.

Causes include:

heart failure
hypoproteinaemia (e.g. nephrotic syndrome)
constrictive pericarditis
hypothyroidism
Ovarian tumours producing right-sided pleural effusion - Meigs' syndrome

Exudates:

The protein content of exudates is more than 30 g/L and the LDH is less than 200 IU/L.

Causes include:

bacterial pneumonia (common)
carcinoma of the bronchus and pulmonary infarction - fluid may be blood-stained (common)
tuberculosis
connective-tissue disease
post-myocardial infarction syndrome (rare)
acute pancreatitis (high amylase content) (rare)
mesothelioma (rare)
sarcoidosis (very rare)
yellow-nail syndrome (effusion due to lymphoedema) (very rare

Light’s criteria for Exudate:

Sensitivity 100%

Specificity 72%

1-the ratio of pleural fluid to serum protein is >0.5

2-the ratio of pleural fluid to serum LDH is >0.6

3-the pleural fluid LDH is >⅔ of the upper limit for blood LDH level

Albumin gradient:

Serum-effusion albumin gradient

Sensitivity 95%

Specificity 100%

Gradient <1.2 g/dl indicate exudate

Gradient >1.2 g/dl indicate transudate

Examin this patient chest.

proceed as follow:

inroduction/exposture

stand at the edge of the bed.

observe if the patient is SOB,respiratory movements,scar,aspiration mark.

features:

1-decrease movement in the left side

2-stony dullness

3-deminished breath sounds.

4-decrease vocal resonance

5-dont forget the trachea position

common questions:

differential diagnosis of dullness.

how would you investigate this patient?

how would differentiate between exudate and transudate and what the common causes of each?

look for clues...!

clubbing,nicotine staining,lymphadenopathy,radiation marks,etc

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