Increased pleural fluid - pleural effusion

increased pleural fluid - pleural effusion

• altered Starling forces
• decreased lymph flow

evaluation of pleural effusion

• sample fluid if pt. has infection (e.g., pneumonia) - thoracentesis

atelectasis mimics pleural effusion (blockage of left main-stem bronchus)

neurovascular bundle is under rib.  needle should go just above rib.

NEJM medical procedures website

Pleural fluid studies

pH low in pts. with high tumor burden

cyology to look for malignant cells

transudate (pressure/oncotic forces) or exudate (capillary damage, inflammation)

• exudate
• pleural fluid protein/serum protein > 0.5
• pleural fluid LDH/serum LDH >0.6
• inflammation of the lung or pleural space
• top 3 causes
• infection
• parapneumonic effusion
• drain when pH < 7.2, pus, glucose <60, LDH > 1000  High LDH indicates cell or tissue damage
• Tuberculosis pleural effusion - immunologic reaction to TB mycobacteria.  high lymphocytes.
• pulmonary embolism
• tend to be blood tinged
• may be transudates
• malignancy 
• blood tinged pleural effusion, high lymphocytes
• other
• collagen vascular disease (lupus, arthritis)
• subdiaphragmatic inflammation
• drug reactions
• hypothyroidism
• asbestos exposure
• pleural fluid chemistry
• lymphocytosis - TB, malignancy, chylothorax (rupture of thoracic duct = increased lymphatic fluid)
• eosinophilia - blood or air in pleural space (mechanism unknown), parasitic or fungal infections, prior asbestos exposure.
• low pH (<7.2) - malignancy, esophageal rupture, parapneumonic effusion
• pleural fibrosis
• undrained blood or effusion in pleural space

• transudate
• increased pulmonary capillary pressure (left side heart failure)
• increased bronchial capillary pressure (right side heart failure)

pleural effusion (NEJM article)