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Wet, Wacky Lungs: A Quick Look At Pleural Effusions

There are many, many different causes of pleural effusion, with the most common being congestive heart failure. A diagnostic thoracentesis in conjunction with the application of Light’s criteria can help narrow the diagnosis.

An X-ray is simple and a mainstay in diagnosis of any patient with suspected pleural effusion. Ultrasound is rising as a more sensitive means of diagnosing effusion, and is also helpful in aiding drainage of effusion. CT has value in determining more complex underlying characteristics of an effusion, but is typically not essential to perform in the ED.

If a patient comes in unstable and an X-ray showing a large pleural effusion causing mediastinal…

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 EM Diagnostics: Pleural Fluid and Ascitic Fluid Analysis

As you think through how to interpret the labs sent from the fluid analysis, you remember something about Light's Criteria but can't remember the specifics...

Articles of Interest

ED evaluation and management of pleural effusions: One size doesn’t fit all

Typically, you should not drain more than 1 liter of fluid. Draining more than 1 liter of fluid can cause re-expansion pulmonary edema (patient becomes unstable and has frothy sputum). Your patient develops a cough during the thoracentesis. Should you be worried? Not really. This cough is probably a sign of physiologic lung re-expansion or pleural irritation from the tube.

Lung Monsters

Ultrasound is excellent in diagnosing the presence and volume of pleural fluid, and in assessing whether the fluid is amenable to aspiration.

Pearl of the Day: Empyema

Diagnosis - diagnostic criteria: aspiration of grossly purulent material on thoracentesis and at least one of the following: thoracentesis fluid with positive Gram stain or culture, pleural fluid glucose < 40 mg/dL, pH < 7.1, or LDH > 1000 IU/L.

PoCUS – Pleural Effusion

Pleural effusion is assessed by ultrasound placing the transducer in the midaxillary line with the marker oriented toward the patient’s head. On the patient’s right side the diaphragm, the liver, and the vertebral line can be seen.

Podcast #50: Pleural Effusion

For treatment, if the effusion is large you would want to take out about 1500 ccs of the fluid. If it is a chronic pleural effusion the patient will receive a chest tube as well as an infusion with a talc slurry. These patients usually have some malignancy causing their pleural effusions.

Resources

Light's Criteria for Exudative Effusions

Provides Light's Criteria to help determine if pleural fluid is exudative.