4- pleural malignancy + infection Flashcards
what is pleural effusion?
abnormal collection of fluid in pleura (common presentation of numerous diseases)
what imaging should be done for pleural effusions?
posterior-anterolateral chest x-ray
what does straw coloured pleural fluid appearance indicate?
cardiac failure or hypoalbuminaemia
what does bloody pleural fluid appearance indicate?
trauma. malignancy, infection, infarction
what does turbid/milky pleural fluid appearance indicate?
empyema or chylothorax
what does foul smelling pleural fluid appearance indicate?
anaerobic empyema
what does food particles in pleural fluid appearance indicate?
esophageal rupture
what could be reason for bilateral pleural effusion?
left ventricular heart failure, pulmonary thromboembolism, drugs, systemic path
what does pH of pleural fluid mean?
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
what do cells in in effusion fluid suggest? (lymphocytes - neutrophils)
lymphocytes = think TB, malignancy although any long standing effusion will become lymphytic
neutrophils = suggest acute process
what do these tests show: (test of pleural fluid in effusion)
a) amylase
b) triglycerides
c) cholesterol crystals
d) creatinine
e) adenosine deaminase
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
what is meant by ancillary fluid?
buildup of fluid in body cavity tissue that is secondary to other primary condition such as tumour effects
what is thoracoscopy?
minimally invasive surgery used to visualise, diagnose + treat conditions. it can allow fluid to be drained or a biopsy to be taken
what are 2 ways of sampling tumour in pleural cavity?
CT guided needle pleural biopsy and thoracoscopy
what is talc pleurodesis?
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
what are long-term pleural catheters?
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
what is treatment of effusions in left ventricular failure?
diuretics
what is treatment of effusions in infection?
drain, antibiotics, may require surgery
what is treatment of effusions in malignancy?
drain, pleurodesis, long term pleural catheter
what is a primary pneumothorax?
occurs spontaneously in otherwise healthy individuals - more common in tall thin men who smoke, vape etc
(pneumothorax is air in pleural space)
what is secondary pneumothorax?
occurs as a result of underlying lung disease or injury
what are some risk factors for secondary pneumothorax?
COPD, astha, cystic fibrosis, LAM (lymphangioleiomyomatosis), langerhans cell histiocytosis, ILD (interstitial lung disease), pneumonia, HIV, cancer, TB, marfans
what is management options of pneumothorax?
= 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
when is surgery of pneumothorax needed?
- if 2 on one side
- if 1 on both sides
- if persistent ones
what is tension pneumothorax? and what are signs?
= 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
what is empyema?
pus in pleural cavity - can occur due to pleural infections
what is treatment of empyema?
usually give 6 weeks of antibiotics
*aminoglycosides don’t get into pleural space!
- can also drain
