pleural effusion

• related: Pulmonology, chest tube
• tags: #literature

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Pathophysiology

• pleural effusion pathophysiology
• heart failure patients more likely to have right sided pleural effusion
• Meig syndrome can have pleural effusion
• pleural thickening on CT can indicate chronic inflammation or malignancy
• triangle of safety for thoracentesis

Fluid analysis

• lights criteria for pleural effusion includes protein and LDH
• transudative vs exudative pleural fluid causes
• diuretic use will cause exudative effusion in heart failure patients
• pleural fluid with very high LDH and low glucose are found in either empyema or rheumatoid pleurisy
• triglyceride over 110 in pleural fluid suggests chylothorax
• lymphocyte predominant pleural fluid suggests lymphoma or TB
• eosinophilia in pleural effusion suggests BAPE, air, PE, or cancer
• elevated amylase in pleural effusion suggests esophageal rupture or pancreatitis
• pleural effusion in TB are exudative, lymphocyte predominant, have low glucose, and elevated adenosine deaminase
• chylothorax is elevated TG with low cholesterol
• complex effusion means septation on ultrasound
• hemothorax is when fluid hematocrit is over half of serum hematocrit
• LDH is higher in pleurodesis patients
• use radioisotope scan to diagnose hepatic hydrothorax
• urinothorax is associated with obstructive uropathy after trauma or surgery
• use rapid score for pleural effusion

Parapneumonic effusion and Empyema

• simple effusion, uncomplicated, complicated parapneumonic effusion, empyema
• antibiotic duration for parapneumonic effusions
• spontaneous bacterial empyema SBEM is empyema without pneumonia

Thoracentesis and chest tube

• indications for diagnostic and therapeutic thoracentesis
• when to place chest tube for pleural effusion
• timing and frequency of tpa
• give intrapleural tpa when chest tube drainage is smaller than expected with residual fluid on imaging
• chest tube can be removed when drainage is less than 120 cc in 24 hours and pleural effusion is small on imaging
• complex fluid on US does not equal to loculation on CT or complicated effusion
• measuring pleural elastance to determine lung entrapment
• trapped lung physiology is result of chronic lung entrapment
• removing small or large amount of pleural effusion have the same risk of reexpansion pulmonary edema

Malignant pleural effusion

• malignant pleural effusion are exudative, lymphocyte predominant, and often bloody
• 3 separate thoracentesis can detect up to 90 percent malignant effusions
• chemical pleurodesis for patients with longer expected survival or faster recurrent pleural effusion
• use TPA and not dornase for malignant pleural effusion
• avoid tpa in malignant pleural effusion with increased bleeding risks
• pleurx catheter results in fewer pleural procedure than talc pleurodesis
• talc slurry for pleurodesis

Post op pleural effusion

• post op pleural effusion can happen in CABG patients

Literature notes

• Concurrent Intrapleural Instillation of Tissue Plasminogen Activator and DNase for Pleural Infection
• case conference PGY1 timing of TPA dornase
• relative CI:
  • overlying infection
  • 1 lung
  • increased PEEP
  • severe lung disease
  • INR > 2.5, PTT > 2.5x normal
• Increased risks of bleeding
  • Not as much with low platelet
  • increased BUN or creatinine > 6 are high risks for bleeding
• intercostal artery: closer to ribs more lateral you are, usually good > 6cm from spine

Links to this note

• Pulmonology

  • pleural effusion

• simple effusion, uncomplicated, complicated parapneumonic effusion, empyema

  • related: pleural effusion

• pleural effusion in TB are exudative, lymphocyte predominant, have low glucose, and elevated adenosine deaminase

  • related: pleural effusion, Tuberculosis

• chest tube

  • related: Pulmonology, pleural effusion

• complex fluid on US does not equal to loculation on CT or complicated effusion

  • related: pleural effusion

• transudative vs exudative pleural fluid causes

  • related: pleural effusion, lights criteria for pleural effusion includes protein and LDH

• chylothorax is elevated TG with low cholesterol

  • related: pleural effusion

• diuretic use will cause exudative effusion in heart failure patients

  • related: pleural effusion

• pleural thickening on CT can indicate chronic inflammation or malignancy

  • related: pleural effusion

• elevated amylase in pleural effusion suggests esophageal rupture or pancreatitis

  • related: pleural effusion

• lights criteria for pleural effusion includes protein and LDH

  • related: pleural effusion

• pleural fluid with very high LDH and low glucose are found in either empyema or rheumatoid pleurisy

  • related: pleural effusion, rheumatoid arthritis

• 3 separate thoracentesis can detect up to 90 percent malignant effusions

  • related: pleural effusion

• antibiotic duration for parapneumonic effusions

  • related: pleural effusion

• avoid tpa in malignant pleural effusion with increased bleeding risks

  • related: pleural effusion

• case conference PGY1 timing of TPA dornase

  • related: pleural effusion

• chemical pleurodesis for patients with longer expected survival or faster recurrent pleural effusion

  • related: pleural effusion

• complex effusion means septation on ultrasound

  • related: pleural effusion

• Concurrent Intrapleural Instillation of Tissue Plasminogen Activator and DNase for Pleural Infection

  • related: pleural effusion

• eosinophilia in pleural effusion suggests BAPE, air, PE, or cancer

  • related: pleural effusion

• hemothorax is when fluid hematocrit is over half of serum hematocrit

  • related: pleural effusion

• indications for diagnostic and therapeutic thoracentesis

  • related: pleural effusion

• lymphocyte predominant pleural fluid suggests lymphoma or TB

  • related: pleural effusion

• malignant pleural effusion are exudative, lymphocyte predominant, and often bloody

  • related: pleural effusion

• pleural effusion pathophysiology

  • related: pleural effusion

• pleurx catheter results in fewer pleural procedure than talc pleurodesis

  • related: pleural effusion

• post op pleural effusion can happen in CABG patients

  • related: pleural effusion

• removing small or large amount of pleural effusion have the same risk of reexpansion pulmonary edema

  • related: pleural effusion

• spontaneous bacterial empyema SBEM is empyema without pneumonia

  • related: pleural effusion

• timing and frequency of tpa

  • related: pleural effusion

• trapped lung physiology is result of chronic lung entrapment

  • related: pleural effusion

• triangle of safety for thoracentesis

  • related: pleural effusion

• triglyceride over 110 in pleural fluid suggests chylothorax

  • related: pleural effusion

• urinothorax is associated with obstructive uropathy after trauma or surgery

  • related: pleural effusion

• use radioisotope scan to diagnose hepatic hydrothorax

  • related: pleural effusion

• use TPA and not dornase for malignant pleural effusion

  • related: pleural effusion

• when to place chest tube for pleural effusion

  • related: pleural effusion

• rheumatoid effusions have elevated cholesterol, high LDH, low glucose

  • related: pleural effusion