Pre PACES Podcast #87 Pleural effusion
May 12, 2024
Dr. James Walters, a respiratory consultant specializing in pleural disease, joins to delve into pleural effusions. He offers a clear definition and discusses their prevalence in practice. Insights on bedside clues for diagnosis include checking for clubbing and tracheal deviation. James breaks down essential investigations like chest X-rays and fluid analysis, highlighting the use of Light's criteria. He also outlines management strategies, distinguishing between infections and malignancies, providing valuable tips for PACES candidates.
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Pleural Effusion Is A Sign Not A Diagnosis
- A pleural effusion is excess fluid in the pleural space and becomes clinically detectable around 200–300 mL.
- It signals underlying disease rather than being a primary diagnosis, so seek the cause.
Use Transudate vs Exudate Framework
- Divide causes into transudates (heart, renal, liver failure) and exudates (pneumonia, malignancy, PE, connective tissue disease).
- Use this categorization to guide tailored investigations.
Begin With Focused End‑Of‑Bed Inspection
- Start the exam at end-of-bed inspection and look for systemic clues like clubbing, scars, lymphadenopathy and unequal chest expansion.
- Comment on respiratory compromise (RR, sats, oxygen) and any accessory signs.