Pleural effusion resident survival guide: Difference between revisions

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{{familytree | | | | | B01 | | | B02 | | | | | | | | | | | | | | | | | | | | | |B01= > 10 mm thickness of effusion on USG|B02= Shortness of breath at rest}}
{{familytree | | | | | B01 | | | B02 | | | | | | | | | | | | | | | | | | | | | |B01= > 10 mm thickness of effusion on USG|B02= Shortness of breath at rest}}
{{familytree | | |,|-|-|^|.| | | |!| | | | | | | | | | | | | | | | | | | | | | | }}
{{familytree | | |,|-|-|^|.| | | |!| | | | | | | | | | | | | | | | | | | | | | | }}
{{familytree | | C01 | | C02 | | C03 | | | | | | | | | | | | | | | | | | | | | |C01= No known cause|C02=CHF suspected?|C03=Therapeutic [[thoracocentesis]]}}
{{familytree | | C01 | | C02 | | C03 | | | | | | | | | | | | | | | | | | | | | |C01= No known cause|C02=CHF suspected?|C03=❑ Rule out [[Pulmonary embolism resident survival guide|pulmonary embolism]]<br>❑ Therapeutic [[thoracocentesis]]}}
{{familytree | | |!| | | |!| | | |!| | | | | | | | | | | | | | | | | | | | | | | }}
{{familytree | | |!| | | |!| | | |!| | | | | | | | | | | | | | | | | | | | | | | }}
{{familytree | | D01 | | |!| | | D02 | | | | | | | | | | | | | | | | | | | | | |D01=❑  Proceed with [[thoracocentesis]]|D02= ❑ Remove up to 1500 ml of fluid}}
{{familytree | | D01 | | |!| | | D02 | | | | | | | | | | | | | | | | | | | | | |D01=❑  Proceed with [[thoracocentesis]]|D02= ❑ Remove up to 1500 ml of fluid}}

Revision as of 21:35, 19 February 2014

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Twinkle Singh, M.B.B.S. [2]

Definition

Pleural effusion is defined as the presence of excessive fluid in the pleural cavity resulting from transudation or exudation from the pleural surfaces.

Light's Criteria

Pleural fluid is classified as an exudate if one or more of the following criteria are met.

Pleural fluid protein divided by serum protein > 0.5
Pleural fluid LDH divided by serum LDH > 0.6
Pleural fluid LDH > 2/3 of upper limit of normal serum LDH

Causes

Life Threatening Causes

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.

Common Causes

Transudate

Exudate

Initial Diagnosis

 
 
 
 
 
 
Characterize the symptoms

Shortness of breath
Chest pain

Cough
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Physical examination

❑ Asymmetrical chest expansion
❑ Dullness to percussion
❑ Decreased tactile fremitus
❑ Mediastinal shift]

❑ Shift away from the effusion side in massive effusion
❑ Shift towards the effusion side in lobar bronchial obstruction
❑ Decreased breath sounds
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Signs suggestive of specific etiology
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Congestive heart failure

❑ Distended neck veins
❑ S3 heart sound

Peripheral edema
 
 
Hepatic cause

Signs of liver failure

Ascites
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Chest radiograph
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Chest radiograph equivocal?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Approach to Thoracocentesis

 
 
 
 
 
 
Assess the clinical significance of pleural effusion
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
> 10 mm thickness of effusion on USG
 
 
Shortness of breath at rest
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
No known cause
 
CHF suspected?
 
❑ Rule out pulmonary embolism
❑ Therapeutic thoracocentesis
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
❑ Proceed with thoracocentesis
 
 
 
 
 
 
❑ Remove up to 1500 ml of fluid
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
❑ Bilateral effusion
❑ Afebrile
❑ No chest pain
 
❑ Unilateral effusion
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
❑ Trial of diuretics
 
❑ Proceed with Thoracocentesis
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Effusion did not resolve in 3 days?
 
❑ Proceed with Thoracocentesis
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Pleural Fluid Analysis

Do's

Dont's

References