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Aetiology. Exudative Pleural Effusions. What is an Exudate?. A cloudy fluid containing proteins and cellular debris which has escaped from blood vessels and has been deposited in tissues, or on tissue surfaces, usually as a result of inflammation.

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Exudative Pleural Effusions

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what is an exudate
What is an Exudate?

A cloudy fluid containing proteins and cellular debris which has escaped from blood vessels and has been deposited in tissues, or on tissue surfaces, usually as a result of inflammation.

  • Transudative and exudative pleural effusions are distinguished by measuring the lactate dehydrogenase (LDH) and protein levels in the pleural fluid.
  • LDH is an enzyme which is important to the production of energy in cells. When cells die LDH is released and escapes into the blood.
  • Exudative pleural effusions meet at least one of the following criteria, whereas transudative pleural effusions meet none:
  • 1. pleural fluid protein/serum protein >0.5
  • 2. pleural fluid LDH/serum LDH >0.6
  • 3. pleural fluid LDH more than two-thirds normal upper limit for serum
causes of exudative pleural effusions
Causes of Exudative Pleural Effusions
  • Parapneumonic causes
  • Malignancy (carcinoma, lymphoma, mesothelioma)
  • Pulmonary embolism
  • Collagen-vascular conditions (rheumatoid arthritis, lupus)
  • Tuberculous
  • Asbestos exposure  
  • Trauma
  • Postcardiac injury syndrome
  • Esophageal perforation
  • Radiation pleuritis
  • Drug use
  • Chylothorax

Once an exudative pleural effusion has been established from the fluid test, the causes can be investigated.

An exudative pleural effusion is not a pathology in itself and is always caused by something else such as:

  • Mesothelial cells are the superficial cells lining the lungs
  • They produce a transudate fluid to allow smooth movement of the lungs as they expand and contract whilst breathing
  • Mesothelioma causes pleural thickening that prevents lymphatic drainage of pleural fluid, causing fluid to build up- A pleural effusion
  • The Most common cause of mesothelioma is inhalation of asbestos fibres.
  • Asbestos fibres are very fine and once they have been inhaled they cannot be exhaled or coughed out
a few facts
A Few Facts
  • Cancer research uk 2009
  • 70-80% of people diagnosed with mesothelioma say they have been exposed to asbestos at some point in their life
  • Mesothelioma can not just affect the pleura but also the pericardium and peritoneum.
  • Pleural mesothelioma can spread to the pericardium quite easily due to the hearts close proximity to the pleural lining.
  • National Macmillan Mesothelioma Resource Centre 2008
  • In the United Kingdom almost 2000 people a year are diagnosed with mesothelioma
  • Mesothelioma has a latency period meaning it can take from 15 to 45 years for asbestos to mesothelioma to occur and show any symptoms at all.

Goldberg, Persky and White (2009) ‘Mesothelioma Centre’ [Online rescource] available at:http://www.mesotheliomacenter.org/about/pleural-mesothelioma.php accessed 28/12/2009

Daniel L. Miller (2009) ‘Extrapleural Pneumonectomy’ CTSnet [online rescourse] Available at: http://www.ctsnet.org/sections/clinicalresources/thoracic/expert_tech-7.html accessed 2812/2009

Jeffrey Rubins (2009) ‘pleural effusion’ eMedicine [online rescource] Available at: http://emedicine.medscape.com/article/299959-overview accessed: 28/12/2009

National Macmillan Mesothelioma Resource Centre 2008 ‘mesothelioma uk’ [online rescource] available at http://www.mesothelioma.uk.com/index.php?pageno=18 accessed 28/12/2009

Cancer research UK 2009 ‘mesothelioma’ [online rescource] available at http://www.cancerhelp.org.uk/type/mesothelioma/index.htm accessed:28/12/2009

Victor L Roggli, thomas A Sporn and tim d ovry (2004) ‘pathology of asbestos associated disease’2nd Edition, springer, New York.

Harvey I Pass, Nicholas J Vogelzang Michele Carbone (2005) ‘Malignant mesothelioma- advances in pathogenesis, diagnosis and translational therapies’ Springer, New York