Diseases of Pleura Flashcards
When do pleural effusions develop?q
Increased fluid entry - Increase in microvascular pressure - Heart failure - Increase in permeability - Inflammation - Malignancy - Decrease in plasma oncotic pressure Decreased fluid exit via lymphatics - Infiltration by - Tumour - Injury - Inflammation
What biochemistry is performed on pleural effusions to assist in diagnosis?
Protein
Glucose
LDH
pH
How can you tell if a pleural effusion is transudative or exudative via its protein content?
Fluid protein/serum protein
If <0.5 > transudative
If >0.5 > exudative
How can you tell if a pleural effusion is transudative or exudative via its LDH content?
Fluid LDH/serum LDH
If <0.6 > transudative
If >0.6 > exudative
How can you tell if there is an empyema present by assessing the pleural effusion?
Glucose <5.5
Acidic
What are the common causes of transudative pleural effusions?
Chronic liver disease
Heart failure
Renal failure
What other investigations help evaluate a pleural effusion?
Imaging - CXR - US - CT chest Bronchoscopy - not routine unless suspecting TB/cancer Thoracoscopy
What are the signs on plain x-ray of a pleural effusion?
Can't see costophrenic angle Meniscus sign Uniform opacification No air bronchogram - Unless underlying consolidation/collapse > seen above meniscus
What is the meniscus sign in the supine lateral chest x-ray?
Laminar sign
What are the symptoms of pleural disease?
Pleuritic chest pain = pleurisy
SOB
Cough
What are the signs of pleural disease?
Air in pleural space - Decreased chest expansion - Increased percussion note - Decreased breath sounds Fluid/solid tissue in pleural space - Decreased chest expansion - Stony dull percussion note - Decreased breath sounds
What are the possible causes of bilateral pleural effusion?
Heart failure Fluid overload Low serum protein - Nephrotic syndrome - Liver disease Inflammatory Secondary malignancy
What are the possible causes of unilateral pleural effusion?
Infection - including TB Malignancy - Primary - Secondary - Lymphoma Inflammatory - including post PE Heart failure - less common
What is a primary pneumothorax?
Just pneumothorax, with no underlying lung disease
What is a secondary pneumothorax?
Pneumothorax with underlying lung disease
Why do pneumothoraces occur?
Spontaneous Trauma Underlying lung disease - COPD - Lung bullae
What are the risk factors for a spontaneous pneumothorax?
Smoking
FHx
Marfan’s syndrome
What is the initial management of air in the pleural space?
Observation Drainage - Aspiration - ICC with underwater seal Pain relief O2
What is the management of a possible empyema?
Sample fluid - Protein - Glucose - pH - Culture - Cytology Start Abx Analgesia Fluids O2 Drain fluid
What might cause pleural plaques?
Asbestos exposure
Previous empyema/blood in pleural space
What are some asbestos-related lung diseases?
Pleural plaques Pleural thickening/pleural effusions Pulmonary fibrosis Mesothelioma Bronchogenic lung carcinoma
What is the management for malignant pleural effusion?
Depends on symptoms and prognosis Drainage with inter-costal catheter - Very good for symptom relief Treat underlying malignancy Pleurodesis Intrapleural catheter
What is pleurodesis?
Obliterate pleural space to prevent pleural effusion or pneumothorax, or to treat persistent pneumothorax
