Pleural Disease

Pleural Disease

Pleural Effusion

Pathology:                    Increasein fluid formation and/or absorption in the pleural space.  The pathology is dependent on aetiology anddivided into transudates and exudates.


Aetiology:                     Exudate (protein >35g/L) due to increased microvascular permeability

-         Malignancye.g. metastatic carcinoma, mesothelioma

-         Infectione.g. TB, parapneumonic, empyema

-         Inflammatione.g. SLE, RA, post-CABG, benign asbestos effusion and drugs


Transudate (protein <35g/L) due to hydrostaticpressure or osmotic pressure:

-         Cardiace.g. LVF, mitral stenosis, constrictive pericarditis

-         Renale.g. peritoneal dialysis, Nephrotic syndrome

-         Livere.g. cirrhosis, ascites, hypoalbuminaemia

Text Box: Light’s Criteria For Pleural Effusions
	Exudate	Transudate
Pleural Fluid Protein/
Serum Protein Ratio	>0.5	<0.5
Pleural Fluid LDH	>2/3 Upper Limit of LDH	<2/3 Upper Limit of LDH
Pleural Fluid LDH/
Serum LDH Ratio	>0.6	<0.6

If one or more Exudate criteria are met then the fluid is identified as Exudative













Symptoms:                   Shortnessof breath, occasional pleuritic pain


Signs:                              Tracheadisplaced away from effusion, reduced chest movement on affected side, stonydull percussion, reduced vocal fremitus, reduced breath sounds      


Investigations:          Imaging: Chest X-Ray ultrasound, CTchest

Pleural Fluid: Diagnostic aspiration

Pleural Biopsy: e.g. Abram’s needle, radiologically guided, VATs

Fluid Samples: LDH and protein, M,C&S, AFB andTB culture


Treatment:                  Treatunderlying cause

Therapeutic aspiration of 1-1.5L can be performed forsymptomatic effusions

In some cases a chest drain may be needed.


Complications:          Breathlessness,empyema    


Prognosis:                    Dependentof cause













Figure 2.3 Large rightand small left pleural effusions

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