The document outlines the mechanisms and types of pleural effusions, distinguishing between transudates and exudates and their common causes such as heart failure and malignancy. It emphasizes clinical assessment through history, physical examination, and diagnostic methods such as CXR and pleural aspiration using Light's criteria for classification. Management focuses on treating the underlying cause, drainage of effusion, and potential surgical interventions.

1. Approach to Pleural Effusion

3. Mechanism

Increase permeability

Increase pulmonary capillary pressure

Decrease negative pleural pressure

Decrease oncotic pressure

Obstructed lymphatics

4. Types of pleural effusions
 Transudates
OR
 Exudates

5. Causes of pleural effusion
Transudates
 Very Common causes
 Heart failure
 Liver cirrhosis

6. Transudates
 Less Common causes
 Hypoalbuminaemia
 Peritoneal dialysis
 Hypothyroidism
 Nephrotic syndrome
 Mitral Stenosis

7. Causes of pleural exudates
 Common causes
 Malignancy
 Parapneumonic effusions
 Tuberculosis

8. Exudates
 Less Common causes
 Pulmonary embolism
 Rheumatoid arthritis and other autoimmune
pleuritis
 Benign Asbestos effusion
 Pancreatitis
 Post-myocardial infarction
 Post CABG

9. Exudates
 Rare causes
 Yellow nail syndrome (and other lymphatic
disorders
 Drugs
 Fungal infections

10. Clinical assessment and history
 Through history and physical examination.

11. Symptoms
 Asymptomatic
 Breathlessness
 Chest pain
 Cough
 Fever

12. Signs
 Decrease expansion
 Dull percusion node
 Decrease vocal resonance
 Decrease air entry
 Signs of associated disease
 (for example :chronic liver disease-CCF-
nephrotic syndrome -SLE-RA-Ca lung)

13. DIAGNOSIS
 CXR
 PLEURAL ASPIRATION
 PLEURAL BIOPSY
 Medical thoracoscopy
 CT scan
 VAT
 Bronchoscopy

15. CXR

19. Pleural aspiration
 The initial step in assessing a pleural effusion
is to ascertain whether the effusion is a
transudate or exudate

20. Light's criteria
 Exudates if one or more of the following:
1. Pleural fluid protein divided by serum protein
is greater than 0.5
2. Pleural fluid LDH divided by serum LDH is
greater than 0.6
3. Pleural fluid LDH > 2/3 the upper limits of
laboratory normal value for serum LDH.

21. Management
 Treatment of the cause
 Drainage (stop drain for 1-2 hours after 1st
1500 ml) may presipitate pul oedema
 Pleurodesis with – talc
– tetracycline
-Bleomycin
Surgery