Pleural lymphatics, What is Pleural Effusion Part 2 - Dr Sheetu Singh

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Pleural lymphatics

• Costal pleura drain ventrally toward nodes along
  the internal thoracic artery and dorsally toward
  the internal intercostal lymph nodes near the
  heads of the ribs.
• Mediastinal pleura drains to the tracheobronchial
  and mediastinal nodes, whereas the diaphragmatic
  pleura drain to parasternal, middle phrenic
  posterior mediastinal nodes.

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Transudative Exudative pleural effusion

• A transudative pleural effusion develops when the
  systemic factors influencing the formation or
  absorption of pleural fluid are altered so that
  pleural fluid accumulates. The permeability of
  the capillaries to proteins is normal in the area
  where the fluid is formed.

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Transudative Exudative pleural effusion

• In contrast, an exudative pleural effusion
  develops when the pleural surfaces or the
  capillaries in the location where the fluid
  originates are altered such that fluid
  accumulates.
• The first question to ask in assessing a patient
  with a pleural effusion is whether that effusion
  is a transudate or an exudate.
• If the effusion is a transudate, no further
  diagnostic pleural procedures are necessary, and
  therapy is directed to the underlying CHF,
  cirrhosis, or nephrosis.
• Alternately, if the effusion proves to be an
  exudate, a more extensive diagnostic
  investigation is indicated to delineate the cause
  of the effusion.

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Transudative Exudative pleural effusion

• Exudative pleural effusions meet at least one of
  the following criteria, whereas transudative
  pleural effusions meet none (Light's criteria)
• Pleural fluid protein divided by serum protein
  greater than 0.5
• Pleural fluid LDH divided by serum LDH greater
  than 0.6
• Pleural fluid LDH greater than two thirds of the
  upper limit of normal serum LDH

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Transudative pleural effusions

• Congestive heart failure
• Cirrhosis
• Nephrotic syndrome
• Superior vena caval obstruction
• Fontan procedure
• Urinothorax
• Peritoneal dialysis
• Glomerulonephritis
• Myxedema
• Cerebrospinal fluid leaks to pleura
• Hypoalbuminemia
• Sarcoidosis