Disease of the pleura Flashcards
What is pleura effusion
when a greater than normal amount of fluid collects within the pleural space
what are the 2 types of pleural effusion
exudate
transudate
what are the common causes of exudate causes of pleural effusion?
increased capillary permeability
inflammation
infective (pneumonia, TB, lung cancer)
neoplastic
what are the common causes of transudate causes of pleural effusion?
increased capillary hydrostatic pressure, or decreased oncotic pressure
heart failure liver failure hypalbuminaemia Meig syndrome (pleural effusion, ascites, ovarian cancer) pulmonary embolism
exudates typically has protein content of what value?
> 35g/L
Transudates typically has protein content of what value?
<25g/L
For borderline effusions (between 25 and
35g/L, apply the Light criteria), what criteria is used to determine if it’s exudate pleural effusion?
Light criteria
According to the Light criteria the pleural effusion is exudates if? (only needs to meet one criteria)
- Effusion protein/serum protein ratio >0.5
- Effusion LDH/serum LDH ratio >0.6
- Effusion LDH more than 0.6 × the upper
limit of normal
what are the clinical features of pleural effusion>
dysponea
pleuritic chest pain
what is the pathognomonic sign of pleural effusion on percussion?
Stony dullness
Other than stony dullness, what are the other signs of pleural dullness?
tracheal deviation
reduced chest expansion
What investigations are done in pleural effusion?
PA CXR
if the pleural effusion is suspected to by exudate–> pleural aspiration via US. 21G needle in a 50ml syringe
pleural fluid test: LDH, Gram stain, cytology, culture
chest drain if there is pleural infection
pleurodesis if necessary
what is pleurodesis?
Pleurodesis (adhering parietal and visceral
pleura with substances such as talc
A pleural fluid pH <7.2 should prompt
suspicion of what?
empyema or a para-pneumonic
effusion (non-infected pleural effusion with
a background of pneumonia). Note that
these require both antibiotics and chest tube
drainage to treat.
what are the borders of the triangle of safety in chest drain
Mid-axillary line
Imaginary horizontal line at the nipple
Lateral border of the pectoris major
The drain is usually sited at the fourth, fifth or
sixth intercostal space
What is a pneumothorax
a process by which there is an abnormal amount of air accumulates in the pleural space
what are the risk factors of pneumothorax
smokers
trauma (chest trauma)
what is an open pneumothorax?
communicating with the exterior
what is an closed pneumothorax?
chest wall is intact, with accumulation of
air in the pleural space
what is a tension pneumothorax
air enters the pleural cavity via a one-way valve and compresses surrounding structures
what is a Primary spontaneous pneumothorax (PSP)
occurs in healthy individuals, with no underlying
lung disease; classically associated with young, tall,
thin men and smokers
what is a Secondary spontaneous pneumothorax (SSP)
usually occurs in individuals with underlying lung
disease, such as COPD, infection, TB, etc
Non-tension spontaneous pneumothoraces can be
classified into what 2 types?
Primary spontaneous pneumothorax (PSP)
Secondary spontaneous pneumothorax (SSP)
what is a catamenial pneumothorax?
a pneumothorax that occurs at the time
of menstruation (linked to endometriosis
involving the pleura).
what are the clinical features of pneumothorax?
sudden-onset dyspnoea or
pleuritic chest pain
decreased chest expansion, reduced breath sounds and hyper-resonance on percussion
how to treat pneumothorax?
Treatment of a tension pneumothorax involves insertion of a large-bore cannula into the second intercostal space at the mid-clavicular line, with subsequent chest drain insertion after the emergent case has been dealt with.
what is Subcutaneous emphysema?
where there is trapped air in
the subcutaneous tissue. This can usually be
felt as crepitus on the face, chest and neck.
It (usually) occurs as a result of air travelling
from the respiratory system or GI tract, and
may be caused by pneumothoraces, gunshot
wounds or infections (e.g. gas gangrene/
Clostridium perfringens)
management of pneumothorax
PA CXR
Distinguish between a primary and
secondary spontaneous pneumothorax
• As a rule of thumb, SSPs involve underlying lung
disease and are less well tolerated than PSPs
Refer to the treatment flow chart
