4- pleural malignancy + infection

Question 1

what is pleural effusion?

Answer 1

abnormal collection of fluid in pleura (common presentation of numerous diseases)

Question 2

what imaging should be done for pleural effusions?

Answer 2

posterior-anterolateral chest x-ray

Question 3

what does straw coloured pleural fluid appearance indicate?

Answer 3

cardiac failure or hypoalbuminaemia

Question 4

what does bloody pleural fluid appearance indicate?

Answer 4

trauma. malignancy, infection, infarction

Question 5

what does turbid/milky pleural fluid appearance indicate?

Answer 5

empyema or chylothorax

Question 6

what does foul smelling pleural fluid appearance indicate?

Answer 6

anaerobic empyema

Question 7

what does food particles in pleural fluid appearance indicate?

Answer 7

esophageal rupture

Question 8

what could be reason for bilateral pleural effusion?

Answer 8

left ventricular heart failure, pulmonary thromboembolism, drugs, systemic path

Question 9

what does pH of pleural fluid mean?

Answer 9

pH test = biochemical test. if less than 7.3 then more likely to have infection, if less than 7.2 then needs drainage

• don’t check if pus

Question 10

what do cells in in effusion fluid suggest? (lymphocytes - neutrophils)

Answer 10

lymphocytes = think TB, malignancy although any long standing effusion will become lymphytic
neutrophils = suggest acute process

Question 11

what do these tests show: (test of pleural fluid in effusion)
a) amylase
b) triglycerides
c) cholesterol crystals
d) creatinine
e) adenosine deaminase

Answer 11

a) raised in pancreatitis + oesophageal rupture
b) chylothorax (trauma to lymphatics, malignancy)
c) pseudochylothorax - similar to chylothorax but not actually lymphatic fluid (TB + RA)
d) raised in urinothorax
e) raised in TB

Question 12

what is meant by ancillary fluid?

Answer 12

buildup of fluid in body cavity tissue that is secondary to other primary condition such as tumour effects

Question 13

what is thoracoscopy?

Answer 13

minimally invasive surgery used to visualise, diagnose + treat conditions. it can allow fluid to be drained or a biopsy to be taken

Question 14

what are 2 ways of sampling tumour in pleural cavity?

Answer 14

CT guided needle pleural biopsy and thoracoscopy

Question 15

what is talc pleurodesis?

Answer 15

procedure to manage recurrent pleural effusion (can be due to cancer)

• the talc powder irritates leading to inflammation + scarring which helps fuse the 2 layers of pleura together preventing fluid accumulation

Question 16

what are long-term pleural catheters?

Answer 16

also known as indwelling pleural catheters (IPC)
they are flexible tubes inserted into pleural space to drain fluid continuously over extended period of time. they put in as Z shape under skin so can’t be pulled out

Question 17

what is treatment of effusions in left ventricular failure?

Answer 17

diuretics

Question 18

what is treatment of effusions in infection?

Answer 18

drain, antibiotics, may require surgery

Question 19

what is treatment of effusions in malignancy?

Answer 19

drain, pleurodesis, long term pleural catheter

Question 20

what is a primary pneumothorax?

Answer 20

occurs spontaneously in otherwise healthy individuals - more common in tall thin men who smoke, vape etc

(pneumothorax is air in pleural space)

Question 21

what is secondary pneumothorax?

Answer 21

occurs as a result of underlying lung disease or injury

Question 22

what are some risk factors for secondary pneumothorax?

Answer 22

COPD, astha, cystic fibrosis, LAM (lymphangioleiomyomatosis), langerhans cell histiocytosis, ILD (interstitial lung disease), pneumonia, HIV, cancer, TB, marfans

Question 23

what is management options of pneumothorax?

Answer 23

= give oxygen (increases thoracic pressure)

• No treatment if asymptomatic and small
• Aspiration 1st line in PSP
• Avoids chest drain
• Time consuming
• May fail esp if age >50 or SSP
• Chest drain
• May need suction (air leak >48 hours)
• Surgical intervention

Question 24

when is surgery of pneumothorax needed?

Answer 24

• if 2 on one side
• if 1 on both sides
• if persistent ones

Question 25

what is tension pneumothorax? and what are signs?

Answer 25

= when enters pleural space and can’t escape
= emergency = stick needle in

signs→if trachea deviated, hypotension, raised JVP, reduced air entry on affected side

Question 26

what is empyema?

Answer 26

pus in pleural cavity - can occur due to pleural infections

Question 27

what is treatment of empyema?

Answer 27

usually give 6 weeks of antibiotics

*aminoglycosides don’t get into pleural space!

• can also drain