![]() Pleural aspiration involves sticking a needle through the chest wall into the effusion and aspirating the fluid. More significant effusions often need aspiration or drainage. This helps establish the underlying cause by measuring the protein content, LDH, cell count, pH, glucose and microbiology testing.ĭiagnosing and treating the underlying cause is the mainstay of management.Ĭonservative management may be appropriate as small effusions will resolve with treatment of the underlying cause. Pleural fluid analysis requires a sample taken by aspiration or chest drain. Ultrasound and CT can detect smaller effusions than a chest x-ray, estimate the volume and identify potential causes. Tracheal and mediastinal deviation away from the effusion in very large effusions.Larger effusions will have a meniscus (a curving upwards where it meets the chest wall and mediastinum).Tracheal deviation away from the effusion in very large effusions.Dullness to percussion over the effusion.The typical presenting symptom is shortness of breath. The pleural effusion and ascites resolve with the removal of the tumour. TOM TIP: Meigs syndrome involves a triad of a benign ovarian tumour (usually a fibroma), pleural effusion and ascites. Transudative causes relate to fluid moving across or shifting into the pleural space ( trans- meaning moving across): Infection (e.g., pneumonia or tuberculosis).Cancer (e.g., lung cancer or mesothelioma).The inflammation results in protein leaking out of the tissues into the pleural space ( ex- meaning moving out of). Pleural fluid LDH greater than 2/3 of the normal upper limit of the serum LDHĮxudative causes are related to inflammation.Pleural fluid LDH / serum LDH greater than 0.6.Pleural fluid protein / serum protein greater than 0.5.Light’s criteria are used for establishing an exudative effusion using protein or lactate dehydrogenase ( LDH): ![]() Transudative – a lower protein content ( less than 30g/L).Exudative – a high protein content ( more than 30g/L).Pleural effusions can be broadly categorised into: A pleural effusion is a collection of fluid in the pleural space.
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