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How much fluid does it take to blunt a costophrenic angle?
200 to 500 mL, normal number of mL, 0.1-0.2mL/kg.
How much fluid can fill a subpulmonic effusion?
1 L, but you can figure it out from the apex of the diaphragm and any gastric air bubbles: apex of "hemidiaphragm" more lateral, gastric air bubble too inferior.
In the supine position, how does a pleural effusion look?
Blurring of lung fields, tapering towards apices.
What effusions need to be tapped?
Less than 10mm of layering of free-flowing fluid, or CHF, if they respond to treatment.
What are Light's criteria for exudate?
Pleural fluid/serum protein ratio > 0.5,
Pleural fluid/serum LDH ratio > 0.6,
Pleural fluid LDH > 2/3 upper limit of normal.
What causes transudative effusions?
CHF, hepatic hydrothorax, nephrotic syndrome, peritoneal dialysis, hypoalbuminuria, urinothorax, "ex vacuo" from collapse lung, SVC syndrome.
What causes exudates?
Trauma, inflammation, cancer, pleural disease, but also PE:
Collagen-vascular diseases (RA, SLE),
Pulmonary Embolism (PE),
Post Cardiac Injury Syndrome (PCIS, Dressler's),
Chylothorax (disruption of thoracic duct,
Abdominal origin (pancreatitis,abcess),
What are guidelines for parapneumonic pleural effusions?
Large amounts of fluid, low pH, or positive cultures require action!
What are the three most common causes of malignant effusions?
Lung cancer, breast cancer, and lymphoma causes 75% of pleural effusions.
Do all malignant effusions need treatment?
Only if symptomatic and also depending on expected survival and presence of trapped lung.
Do TB effusions resolve?
Usually, but they lead to pulmonary disease within 5 years in high percentage of cases.
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