Diseases of pleura Flashcards
What is pleura made of?
mesothelial cells and sub-pleural connective tissue
How much fluid is there in pleural space?
2-3 ml
How is the pleural fluid formed?
It is formed from systemic circulation, as the hydrostatic pressure there is 4 kPa whereas in pulmonary arteries it is 1.5kPa. Thus the overall net flow is from the systemic circulation to pleural scape and to lungs
Which organs does pleural membrane cover?
Spleen, kidneys, liver
What is pleural effusion?
Abnormal accumulation of fluid in pleural space
What are the symptoms of pleural effusion?
can be asymptomatic, breathlessness, dry cough, pleuritic chest pain, dull ache, fevers, night sweats
What are the signs of pleural effusion?
Decreased expansion, stony dullness on percussion, reduced breath sounds, absent vocal resonance, other signs such as clubbing, raised JPV, peripheral oedema, cervical lymphadenopathy, trachea away from effusion
What are the two types of pleural effusion?
Transudate and exudate
What is transudate?
Pleural fluid with fluid protein smaller than 30 g/l, imbalance of hydrostatic forces, usually bilateral
What are the common causes of transudate?
left ventricular failure, liver cirrhosis, hypoalbuminaemia, peritoneal dialysis, less common causes are hypothyroidism, nephrotic syndrome, mitral stenosis, pulmonary embolism, rare are constructive pericarditis, ovarian hyper stimulation syndrome, Meigs syndrome
What is exudate ?
Pleural fluid with protein content higher than 30 g/L, usually unilateral, due to increased permeability of the pleural blood vessels
What are the causes of exudate?
Lung, breast, cancer, mesothelioma, parapneumonic, less common pulmonary embolism, rheumatoid arthritis, autoimmune diseases, benign asbestos effusion, pancreatitis, post myocardial infarction, craniotomy syndrome, rare are yellow nail syndrome, due to some drugs
What are the essential investigations?
transudate usually does not require investigation, chest X ray, congrats enhanced CT, aspiration and analysis of the fluid, pleural biopsy, thoracoscopy
What can be determined from aspirated fluid?
Foul smelling -anaerobic empyema, pus -empyema, milky chylothorax, food particles -oesophagus rupture, blood - haemothorax, blood stained -malignancy
What tests can be performed on the pirated fluid?
test for protein, LDH, amylase, glucose, TB, cytology, microbiology
What are the lights criteria?
Used for proteins levels between 25 -35, it is exudate if one or more are true, pleural/serum protein >0.5, pleural / serum LDH >0.6
pleural LDH >0.66 of upper limit of serum LDH
What is the treatment for pleural effusion?
transudate treat the cause, exudate treat by chemotherapy if possible,corticosteroids, palliative aspiration 1.5 L maximum at any one time, pleurodesis chemical or surgical, inflammation should seal the two membranes together
What is pneumothorax?
Collapsed lung with air in the pleural cavity, in can be primary or secondary
What are the different types of pneumothorax?
spontaneous primary, spontaneous secondary, traumatic non-iatrogenic, traumatic iatrogenic
What is primary spontaneous pneumothorax?
No clinically apparent disease, more likely in tall and young people
What is spontaneous secondary pneumothorax?
Occurs in patients with pulmonary pathology such as asthma, COPD< pneumonia, TB, CF, sarcoidosis, fibrosing alveoli
What is traumatic non-iatrogenic pneumothorax?
penetrating chest injury stab, gun shot, blunt chest injuries, broken ribs etc
What is traumatic iatrogenic pneumothorax?
Caused by pleural aspiration, subclavian vein cannulation, lung, liver and renal biopsy, acupuncture
What is tension pneumothorax?
The pressure in the pleural cavity is very big, mediastinal shift, obstructing venous return , circulatory instability, very dangerous, needs to be treated immediately
