Chapter 77 Pleural Disease

Question 1

Describe pathophysiology behind the pleural space - pressure

Answer 1

The pleural space has a negative pressure (less than surrounding atm pressure) which allows our expanding chest wall to suck open our lungs. Pleural pressures are -10 to -12 mmHg during inspiration and -4 mmHg during expiration.

Once intrapleural pressure reaches above 15-20mmHg (always the answer for elevated compartment pressures), venous blood flow through the SVC and IVC is impaired

Question 2

List 5 risk factors for primary spontaneous pneumothorax?

Answer 2

1) tall
2) male
3) smoker
4) changes in ambient pressures
5) Hx of mitral valve prolapse
6) marfan syndrome
7) family history of primary PT|X

Question 3

What is the most common pathophysiologic cause of PTX? (primary and secondary)

Answer 3

Primary:

• unrecognized pleural disease
• rupture of a bleb

Secondary
-COPD

Question 4

List 8 causes of secondary spontaneous pneumothorax

Answer 4

Airway diseases:

1) COPD
2) asthma
3) Cystic fibrosis

Infections lung:

1) lung abscess
2) necrotizing bacterial pneumonia
3) PCP
4) TB

Interstitial lung disease: \

1) sarcoidosis \
2) Idiopathic pulmonary fibrosis
3) lymphangiomyomatosis \
3) tuberous sclerosis
4) pneumoconioses