Pleural Effusion
Causes - just about anything - Chris Nickson
image by: Department of Thoracic Surgery, Services Hospital , Lahore, Pakistan
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Wet, Wacky Lungs: A Quick Look At Pleural Effusions
There are many, many different causes of pleural effusion, with the most common being congestive heart failure. A diagnostic thoracentesis in conjunction with the application of Light’s criteria can help narrow the diagnosis.
An X-ray is simple and a mainstay in diagnosis of any patient with suspected pleural effusion. Ultrasound is rising as a more sensitive means of diagnosing effusion, and is also helpful in aiding drainage of effusion. CT has value in determining more complex underlying characteristics of an effusion, but is typically not essential to perform in the ED.
If a patient comes in unstable and an X-ray showing a large pleural effusion causing mediastinal…
Resources
EM Diagnostics: Pleural Fluid and Ascitic Fluid Analysis
As you think through how to interpret the labs sent from the fluid analysis, you remember something about Light's Criteria but can't remember the specifics...
ED evaluation and management of pleural effusions: One size doesn’t fit all
Typically, you should not drain more than 1 liter of fluid. Draining more than 1 liter of fluid can cause re-expansion pulmonary edema (patient becomes unstable and has frothy sputum). Your patient develops a cough during the thoracentesis. Should you be worried? Not really. This cough is probably a sign of physiologic lung re-expansion or pleural irritation from the tube.
Lung Monsters
Ultrasound is excellent in diagnosing the presence and volume of pleural fluid, and in assessing whether the fluid is amenable to aspiration.
Pearl of the Day: Empyema
Diagnosis - diagnostic criteria: aspiration of grossly purulent material on thoracentesis and at least one of the following: thoracentesis fluid with positive Gram stain or culture, pleural fluid glucose < 40 mg/dL, pH < 7.1, or LDH > 1000 IU/L.
PoCUS – Pleural Effusion
Pleural effusion is assessed by ultrasound placing the transducer in the midaxillary line with the marker oriented toward the patient’s head. On the patient’s right side the diaphragm, the liver, and the vertebral line can be seen.
Podcast #50: Pleural Effusion
For treatment, if the effusion is large you would want to take out about 1500 ccs of the fluid. If it is a chronic pleural effusion the patient will receive a chest tube as well as an infusion with a talc slurry. These patients usually have some malignancy causing their pleural effusions.
Wet, Wacky Lungs: A Quick Look At Pleural Effusions
The most common cause of transudative pleural effusions is heart failure, and the most common cause of exudative pleural effusions is pneumonia. That being said, there are more than fifty causes of pleural effusions...
Light's Criteria for Exudative Effusions
Provides Light's Criteria to help determine if pleural fluid is exudative.
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