Pleural effusion

Pleural Effusion is fluid in pleural cavity. Must know the causes is: It is divided into exudate and transudate.

Exudate :

• Malignancy  (lymphoma, Mg metastasis, bronchogenic carcinoma, mesothelioma) 
• infection (TB, pneumonia)
• connective tissue disease (SLE, RA)
• hypothyrodism

Transudate

• heart failure, pericarditis, fluid overload ( due to increase venous pressure)
• nephotic syndrome, chonic liver disease and malabsorption ( hypoproteinemia)

Light criteria (1/3) - indicates exudate.

1. Pleural protein : serum protein > 0.5
2. Pleural LDH : serum LDH >0.6
3. pleural fluid LDH >2/3 of upper limit of serum LDH.

On examination :

general inspection: sign of maligancy, hypothyrodism, connective tissue disease (SLE, RA), oedema, any neck swelling. 

- sigmata of chronic liver disease.

chest:
inspection : reduce chest expension, surgical scar, radiotheraphy.

palpation : apex beat, trachea deviation ( in massive pleural effusion), 

purcussion: stony dull

auscultation : reduce breath sound, reduce vocal fremitus.

management:
ix:

• pleural aspiration send for glucose, protein , LDH, tb test. pH, amylase
• cxr
• blood 
• plueral biopsy 

Tx: 

• drainage
• pleurodesis with tetracycline, bleomycin
• intrapleural streptokinase
• surgery