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Clinical Pathology > CP9 pleural pathology > Flashcards

CP9 pleural pathology Flashcards

1
Q

What are 5 common pleural pathologies?

A

Inflammation (aka pleurisy)
Pleural effusion
Pneumothorax
Pleural fibrosis
Mesotheliomas

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2
Q

What are the two layers of pleural called?

A

The parietal pleura and the visceral pleura

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3
Q

What two layers are the pleura formed of?

A

Connective tissue layer
Mesothelium layer

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4
Q

Which layer of the pleura line the pleural cavity?

A

Mesothelium

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5
Q

What are characteristics of a normal Mesothelium?

A

A single layer of mesothelial cells which secrete hyaluronic acid to lubricate movement of the pleura against each other during respiration.

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6
Q

What are symptoms of pleurisy?

A

Recent onset sharp chest pain that is exacerbated by deep breathing, coughing or sneezing. Also history of breathlessness

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7
Q

What is a clinical sign of pleurisy?

A

Hearing plural rub upon auscultation

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8
Q

What investigations are involved in diagnosing pleurisy?

A

Blood test
Chest x-ray
CT or ultrasound
Biopsy

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9
Q

What are common causes of pleurisy?

A

Infection (most commonly viral but can also be bacterial)
Pulmonary infarction (can be due to PE)
Emphysema
Neoplasms
Therapeutic/iatrogenic
Collagen vascular disease

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10
Q

How is pleurisy treated?

A

Treat the cause
NSAIDs

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11
Q

What are clinical signs of pleural effusion?

A

Stony dullness upon percussion
Reduced breath sounds upon auscultation

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12
Q

What is it called when serous fluid is in the pleural cavity?

A

Pleural effusion

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13
Q

What is it called when pus is in the pleural cavity?

A

Empyema or phyothorax

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14
Q

What is a common cause for pus in the pleural cavity?

A

Pneumonia

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15
Q

What is it called when blood is in the pleural cavity?

A

Haemothorax

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16
Q

What are the most common causes of haemothorax?

A

Trauma and ruptured thoracic aortic aneurysms

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17
Q

What is it called when there is bile in the pleural cavity?

A

Chylothorax

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18
Q

What is the most common cause of bile in the pleural cavity?

A

Trauma

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19
Q

What is it called when there is air in the pleural cavity?

A

Pneumothorax

20
Q

What white blood cell will be increased in the results from a blood test for a pleural effusion?

A

Neutrophils

21
Q

What are the two types of pleural effusion?

A

Transudates
Exudates

22
Q

What are 3 properties of transudate pleural effusions?

A
  1. Low capillary oncotic pressure +/- high capillary hydrostatic pressure.
  2. Intact capillaries which retain semipermeability
  3. Low protein (<
23
Q

What are 3 properties of exudate pleural effusions?

A

Pathological capillaries lose semipermeability
Capillary oncotic pressure and vascular hydrostatic pressure is normal
High protein (>2.9 g/dL)
High lactate dehydrogenase

24
Q

What causes transudate pleural effusions?

A

Left ventricular failure
Renal failure
Hypoalbuminaemia due to hepatic cirrhosis or nephrotic syndrome

25
Q

What causes exudate pleural effusions?

A

Inflammation with/without infection e.g. empyema
Primary or secondary neoplasms

26
Q

How can you treat pleural effusions?

A

Relieve symptoms
Remove fluid (by aspiration or a drain)
Pleurodesis (stick lung to chest wall)
Treat the cause
Investigate the pleural fluid with cytology, microbiology and biochemistry
(Can also do CT scan/ultrasound +/- pleural biopsy)

27
Q

What are symptoms of pneumothorax?

A

Breathlessness and pleuritic chest pain

28
Q

What are clinical signs of a pneumothorax?

A

Cyanosis
Tachycardia
Contra lateral tracheal deviation (in tension pneumothorax)
Hyper resonance upon percussion
Reduced breath sounds upon auscultation

29
Q

What are the two types of pneumothorax? Where does the air come from for each?

A

Closed (air from inside the lung)
Open (air from outside of the lungs)

30
Q

What are causes of a closed pneumothorax?

A

Ruptured emphysematous bullae
Inflammatory lung diseases e.g. asthma, pneumonia, TB and CF
Trauma where lung torn by fractured rib

31
Q

What causes an open pneumothorax?

A

Trauma causing a chest wall perforation (aka a sucking chest wound) causing external air to enter the pleural cavity during inspiration reducing potential lung expansion

32
Q

What causes a tension pneumothorax?

A

Valvular perforation causing air into the lung cavity during inspiration but not out again on expiration
Pressure build up in a pneumothorax causing compression of the lung

33
Q

How are pneumothorax managed/treated?

A

Can spontaneously decompress
Manually decompressed via needle aspiration via intercostal space
Occlusive adhesive dressing +/- valve
Chest drain +/- valve
Pleurodesis

34
Q

What are 2 causes of pleural fibrosis?

A

Pleural inflammation
Asbestos (causing parietal fibrous plaques or diffusing across the pleura)

35
Q

What are parietal pleural fibrous plaques?

A

Dense areas of poor cellular collagen on pleura associated with low level asbestos exposure

36
Q

What is diffuse parietal fibrosis?

A

High level asbestos dust exposure causing bilateral (usually) fibrosis. The dense cellular collagen does not extend into the interlobar fissures

37
Q

What are symptoms of diffuse pleural fibrosis?

A

Breathing difficulties

38
Q

What is a treatment used for diffuse pleural fibrosis?

A

Pleural decortication

39
Q

What are the two main types of primary pleural cancers?

A

Low grade mesothelial tumours (benign)
Malignant mesothelioma

40
Q

What is the most common secondary tumour in the pleura?

A

Carcinomas

41
Q

Who is most likely to be affected by low grade peritoneal mesotheliomas?

A

Women

42
Q

What is a consequence of a pleural effusion as a result of malignant mesotheliomas?

A

The tumour can metastasise into the effusion

43
Q

What is the main cause of malignant mesothelioma?

A

Asbestos - the longer the exposure, the higher the cancer risk

44
Q

What are the less common causes of malignant mesotheliomas?

A

Spontaneous tumour development (very rare)
Thoracic irradiation
BAP1 mutations (familial cancer syndrome)

45
Q

What are the 3 main types of asbestos?

A

Blue
Brown
White

46
Q

What is asbestos?

A

Fibrous metal silicates that when inhaled forms asbestos bodies

47
Q

What are the 7 main asbestos related diseases?

A

Pleural effusion
Parietal pleural fibrous plaques
Diffuse pleural fibrosis
Malignant mesotheliomas
Asbestosis
Lung carcinomas
Asbestos corns (benign war like skin lesions)

Clinical Pathology (65 decks)

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