24/ MOST COMMONLY EFFUSION D/T CHF - IS BL AND THERE IS GOING TO BE ADDITIONAL SIGNS OF HEART FAILURE SUCH AS RAISED JVP, PEDAL EDEMA, CRACKLES ON LUNG AUSCULTATION, ORTHOPNEA, S3, ETC.. CHF CAN OCCASIONALLY CAUSE A UNILATERAL EFFUSION, BUT IT TENDS TO BE ON THE RIGHT SIDE.
Congestive heart failure commonly causes transudative effusions (bilateral 61%, unilateral right-sided 27%, and unilateral left-sided 12%).
25/ Patient with lung malignancy and in hospice and there is a large pleural effusion that is causing difficulty breathing - NBSIM - therapeutic thoracentesis
26/ Esophageal rupture after endoscopy can result in left sided pleural effusion (amylase rich) NBSID = water soluble contrast esophagography (>>>) or CT contrast to diagnose the esophageal rupture ; NBSIM = Abx + EMERGENCY SURGERY
27/ Case scenario - Boy has some mediastenal mass that is causing compression on the surrounding structures and causing dyspnea, dysphagia, and + pleural effusion), cont...
...→ you then did a thoracentesis and the pleural fluid that was seen had lots of RBC - Dx is hemorrhagic effusion d/t malignancy invasion Malignancy is a common cause of exudative pleural effusions, with lymphoma the most likely cause in a child with a mediastinal mass
28/Patient post CABG with pleural effusion who is asymptomatic, small-moderate sized, on the left side within post op day 1 or 2 - NBSIM = do nothing If it is large/ progressive/ expansive/symptomatic - NBS -> do throacentesis
29/ Physical exam in pleural effusion - decreased breath sounds, decreased tactile fremitus, dullness to percussion, mediastinal shift - away from the affected side if large effusion
30/ Cirrhosis d/t any cause -> now new onset dyspnea in the right side + right side pleural effusion = hepatic hydrothorax NBSIM salt and water restriction ; chest tube placement is generally not done since there is going to be loss of large volume + protein rich fluid
31/ Pleural nodules + exudative effusion + prolonged asbestos exposure = mesothelioma