This is a 80 years old Chinese gentleman with L pleural effusion.
Medical students will often be asked regarding the causes of pleural effusion.
You can divide it into unilateral and bilateral.
Question 1
What are the common causes of unilateral pleural effusion ?
Question 2
What is Light's criteria ?
Question 3
What are the clinical signs of an effusion ?
Question 4
What are the important investigations you would perform to ascertain the underlying aetiology ?
5 comments:
1. Common causes include bronchogenic carcinoma, TB, pneumonia, Pulm. infarct, malignanct metastases?
2. Light's criteria - the fluid is considered exudate if ratio of pleural protein to serum protein is more than 0.5, ratio of pleural fluid to serum LDH is more than 0.6.
3.decreased expansion, stony dull percussion, decreased breathing sound and increased vocal fremitus.
4. Diagnostic aspiration, for bacteriology, cytology, clinical biochemistry and immunology.
Err..when will the result be out? Thanks :-)
good. However, there is one more criteria of Light's. Can you tell me what it is? Don't forget AFB D/S and C & S as investigation.
Another criteria : Pleural fluid LDH is more than two-thirds normal upper limit for serum. I have 2 questions, hope you can answer me. Thanks:-)
1. what do d/s and c&s stand for?
2. In case of pulm. infarct, how do we explain the effusion, is it caused by sterile inflammation n then effusion?.
Yup, you got the Light's criteria correct.
D/S - direct smear
C&S - Culture and sensitivity
As for pulm infarct, it is due to pulm embolism which then causes in rease permeability and increase hydrostatic pressure causing the effusion.
actually i hv a question, about Light's criteria, more likely exudative if
a: ratio of pleural protein to serum protein is more than 0.5
b: ratio of pleural fluid to serum LDH is more than 0.6.
c: Pleural fluid LDH is more than two-thirds normal upper limit for serum
-Question: isn't b and c criteria the same?? i mean, >2/3 is >0.6.
so, i was rather confused with that, and find the c criteria rather redundant. do enlighten me please :) thanks
p/s: refering to SE (q3 answer)- shouldn't it be DECREASE vocal fremitus/resonance in pleural effusion?
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