Clinical: Pleural Disease

Question 1

Most sensitive layer when performing a pneumocentesis.

Answer 1

Parietal Pleura

Question 2

Layer of tissue that reabsorbs pleural fluid.

Answer 2

Parietal Pleura

Question 3

Function of pleural mesothelial cells

Answer 3

Phagocytic

Maintain balance between coagulation and fibrinolysis

Question 4

Where does the pleural fluid originate and where does it drain?

Answer 4

Diffuses into the pleural space from the bronchial and intercostal mircoarteries.

Drains into the bronchial and intercostal veins along with lymphatic vessels.

Question 5

What two mechanisms cause an increase in pleural fluid?

Answer 5

Increased fluid entry due to starling force imbalance

Decreased fluid exit due to inflammation, obstruction (lymphomas), heart failure, or endocrine abnormalities

Question 6

In which systemic conditions is pleural inflammation common?

Answer 6

Lupus, hypothyroidism, amyloid, yellow nail syndrome

Question 7

What are the 3 major causes of pleural fluid transudate?

Answer 7

Cardiac Disease
Kidney Disease
Liver Disease

Question 8

What is Light’s Diagnostic Criteria for a fluid to be considered exudate?

Answer 8

1. Pleural fluid protein/serum ratio greater than 0.5
2. Fluid LDH/serum ratio greater than 0.6
3. Fluid LDH greater than 2/3 of the upper limit of lab normal for LDH

-if one of these is true=exudate
(LDH is lactate dehydrogenase)

Question 9

What are the 3 most important components analyzed in pleural fluid chemical analysis?

Answer 9

Protein
LDH
Glucose

Question 10

What 3 conditions can increase fluid protein concentrations toward the exudate range?

Answer 10

1. Diuresis
2. CHF
3. TB infection

Question 11

What conditions can increase serum LDH levels?

Answer 11

Empyema, rheumatoid pleurisy, pleural paragonimiasis (worm infection), malignancy

Question 12

What 2 major conditions can cause increased glucose levels in pleural fluid?

Answer 12

1. Rheumatoid Pleurisy

2. Complicated parapneumonic effusion or empyema