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Group 3 HEI
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Start up
How much fluid (mL) does each pleural space contain
as normal?
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Normal pleural physiology
Each pleural space produces and reabsorbs up to 15mL of fluid
per day, and contains about 10 mL of fluidat any one time; not
apparent on imaging.
Normal pleural fluid chemistries:
LDH < 0.6 of serum,
protein < 0.5 of serum,
glucose 0.6 to 0.8 of serum,
pH 7.60
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Transudate or exudate?
Lights criteria:
1. pleural fluid protein/serum protein >0.5
2. pleural fluid LDH/serum LDH >0.6
3. pleural fluid LDH > 2/3 ULN for serum
Presence ofany of Light's criteria exudate
Meet none of Lights criteria transudate
BUT the above criteria misidentify ~25% of transudates as
exudates
ULN: upper limit of normal
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PLEURAL EFFUSION
Thoracentesis
Presence ofany of Light's criteria
Maybe exudate Transudate
Patient with CHF or cirrhosis
Exudate Serum protein PF protein > 3.1 g/dL
Further diagnostic procedures
Treat CHF, cirrhosis, nephrosis
NoYes
No Yes
NoYes
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Transudative effusion
Transudative effusions are caused by some
combination of hydrostatic pressure and
plasma oncotic pressure. increase the formation and/or
decrease
reabsorption of pleural fluid
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Transudates - Causes
Congestive heart failure (40%): 80% bilateral, usually
cardiomegaly on CXR
Constrictive pericarditis
Cirrhosis (hepatic hydrothorax): often right-sided
(2/3) & massive (even without marked ascites)
Nephrotic syndrome: usually small, bilateral,
asymptomatic Other: PE (usually exudate), malignancy
(lymphatic
obstruction), myxedema, CAPD
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Exudative effusion
Exudative effusions are caused by local
processes increased capillary permeability
exudation of fluid, protein, cells, and other
serum constituents.
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Exudates Causes
Lung parenchymal infection (25%)
bacterial
mycobacterial
fungal, viral, parasitic (eg, amebiasis,
echinococcosis,paragonimiasis)
Malignancy (15%): primary lung cancer most common,metastases
(esp. breast, lymphoma, etc.), mesothelioma
Pulmonary embolism (10%): exudate (75%) > transudate
(25%)
Collagen vascular disease: RA, SLE Trauma
Surgery
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Questions
Cirrhosis (hepatic hydrothorax): often
causes right-sided pleural effusion
WHY?
Abbreviations: CXR, PE, CAPD, CHF, RA, SLE...
Your question?
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