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DI3302 > 3. Pleural, Mediastinal diseases > Flashcards

3. Pleural, Mediastinal diseases Flashcards

1
Q

What are the diseases of the pleura (4)

A
  • effusion (fluid in pleural space)
  • Pneumothorax/hydropneumothorax
  • Calcification
  • Tumor
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2
Q

Causes of pleural effusion bilaterally (+mc)

A
  • Congestive Heart failure (mc)
  • Cirrhosis w ascites
  • nephrotic syndrome
  • kwashiorkor
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3
Q

causes of pleural effusion unilaterally

A

*more exudate causes

  • Malignancy
  • Infections
  • Autoimmune diseases
  • Infarction
  • Trauma
  • Surgery
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4
Q

When can you see pleural effusion on X-ray and mediastinal shift (in mL)

A

Seen on X-ray >300ml

Mediastinal shift >1000ml

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5
Q

what is the meniscus sign

A

when costophrenic angles become blunted in pleural effusion

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6
Q

What breath sounds will u get in pleural effusion

A

decreased breath sounds

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7
Q

Features of subpulmonic effusion

A

dome more flat

-may be more central effusion as you can kinda still see angles

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8
Q

if you see bilateral blunting what most likely is the cause

A

Heart issues

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9
Q

physical exam findings in pleural effusion

A
  • decreased/inaudible breath sounds
  • tachypnea
  • egophony/pleural rub
  • asymetric expansion of thoracic cage
  • dullness to percussion
  • decreased or absent tactile fremitus
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10
Q

how to tx common (3, CHF, Infection, reumo) pleural effusion conditions

A

treat underlying cause

CHF- Diuretics
Infection- Antibiotics
Rheumatological and inflamatory causes-steroids and NSAIDs

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11
Q

causes of pleural calcification

A

Asbestosis (mc)

Old empyema

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12
Q

causes of pleural calcification

A 
Asbestosis (mc)
Old empyema
Old hemothorax
Old TB
Silicosis
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13
Q

Signs of an extra plural entity

A

Peripheral density
convex toward lung
sharp inner margin (and indistinct outer margin)
Obtuse angle w chest wall (cat under the rug)

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14
Q

causes of extra pleural sign

A
  • rib fracture (mc)
  • callous
  • hematoma
  • rib expansile lesion
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15
Q

radiographic findings of rib fractures

A
  • Radiolucent fracture line
  • cortical offset
  • altered rib orientation
  • pleural deflection
  • callus
  • pneumothorac
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16
Q

what will you see in a pneumothorax

A

Well defined density near hilum (collapsed lung)

-no pleural markings anywhere else

17
Q

Types of pneumothorax

A

Primary (spontaneous)- Young males/tall/thin, most liekly small but could progress to tension type

Secondary- result of trauma or underlying disease
Hydropneumothorax

Tension

18
Q

mc disease cause of secondary pneumothorax

A

COPD

19
Q

physical exam findings of affected side in pneumothorax

A
  • diminished breath sounds
  • hyperresonate on percussion
  • decreased vocal resonance and tactile fremitus
20
Q

What lobe is pneumothorax mc

A

Upper lobe

21
Q

What is a tension pneumothorax and management

A
  • Complete collapse of the lung
  • Air enters pleural space and gets trapped
  • air cannot escape
  • can lead to hypotension,shock,death

SURGICAL EMERGENCY

22
Q

Key signs of tension pneumothorax (3)

A
  • squeezes lung into formless shadow along spine
  • oftern displaces the mediastinum away from the side of collapse
  • may invert diaphragm
23
Q

Clinical findings of tension pneumothorax (4)

A
  • distressed + pain
  • Reduced chest expansion
  • Tachycardia
  • Hyperresonance to percussion and diminished breath sounds on involved side
24
Q

What is the big sign in a hydropneumothorax

A

Presence of air and fluid within pleural space

look for the straight air/fluid line

25
Q

What is the imaging sign of pneumoperitoneum

A

Free air present in the peritoneal cavity

-seen under the hemidiaphrams

26
Q

Causes of pneumoperitoneum (mc)

A

Perforated vicus is primary concern

27
Q

Causes of unilateral diaphragm elevation

A
  • phrenic nerve palsy
  • pulmonary collapse, atelectasis
  • spliniting (traumatic injury)
  • Eventratuon (weakness in part of hemi)
28
Q

What is eventuation of diaphragm

A
  • congenital anomoly
  • failure of mm development of part or all of one or both hemidiaphrams
  • it results in abnormal elevation of the dome of the hemidiaphram involved
  • asymptomatic
29
Q

Bilateral diaphragm elevation causes

A
  • poor inspiration
  • obesity
  • ascites
  • preg
30
Q

widened mediastinum causes

A
  • Aortic aneyrysm, dissection, rupture
  • hilar lympadenopathy
  • esophageal rupture
  • mediastinal masses
31
Q

What is the ddxs for anterior mediastinal masses (3ts + L)

A

Thyroid (goitor or tumor)
Thymic tumour
Teratoma
Lymphoma

32
Q

Middle mediastinal masses ddx

A

Lymphadenopathy

  • thoracic aortic aneurysm
  • Bronchogenic cyst
33
Q

What is the cerivicothoracic sign and what does it indicate

A

Well defined mass seen extending sup to the clavicle on the frontal radiography indicates that the mass is post mediastinum

DI3302 (6 decks)

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