The answer is C – Cirrhosis
Transudative pleural effusions result from an alteration in the formation of pleural fluid, the absorption of pleural fluid, or both, by systemic factors. Transudate = transient → from changes in hydrostatic pressure: cirrhosis, CHF, nephrotic syndrome, ascites, hypoalbuminemia
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Pearls
Pleural effusion is the buildup of excess fluid between the layers of the pleura outside the lungs (pleural space)
- Presents with dyspnea, and a vague discomfort or sharp pain that worsens during inspiration
Differentiate between exudate and transudate with pleurocentesis
- Determine if the pleural fluid is exudative by meeting at least one of Light’s Criteria (increased protein, increased LDH)
- Pleural fluid protein / Serum protein >0.5
- Pleural fluid LDH / Serum LDH >0.6
- Pleural fluid LDH > 2/3
- Transudate = transient → from changes in hydrostatic pressure: cirrhosis, CHF, nephrotic syndrome, ascites, hypoalbuminemia
- Exudative = protein ratio ↑, LDH ↑: infection, malignancy, immune; MC cause = pneumonia, cancer, PE, TB
Diagnosis
Diagnose with lateral decubitus CXR, chest CT, U/S. Thoracentesis is the gold standard
- PE shows decreased tactile fremitus and dullness to percussion in pleural effusion
- Isolated left-sided pleural effusion likely exudative
- Right-sided = transudative
Treatment
Treatment is with thoracocentesis
- Effusions that are chronic or recurrent and causing symptoms can be treated with pleurodesis (pleural space is artificially obliterated) or by intermittent drainage with an indwelling catheter
