Diseases of the Pleura Flashcards
How much pleural fluid is produced daily?
15mL
What is a cardiac cause of pleural effusion?
Heart failure
What should be measured in pleural fluid?
Protein content
LDH
WBC
pH
Cytology
What might a low pH in pleural effusion reflect?
Anaerobic metabolism
What Ix help evaluate a pleural effusion?
CXR
US
CT chest
Bronchscopy
Thoracoscopy
Symptoms of pleural disease?
Pleuritic chest pain
SOB
Cough
What are signs of solid/fluid pleural effusion?
Decreased chest expansion
Decreased percussion note
Decrease breath sounds
Why US a pleural effusion?
In case it’s a raised hemidiaphragm
What are some causes of a unilateral pleural effusion?
Pneumonia/TB
Cancer
Trauma
Inflammatory (including post PE)
What are some causes of a bilateral pleural effusion?
Heart failure (most most common)
Low oncotic state
Inflammatory
Malignancy (secondary ie mets)
What are some causes of pneumothoraces?
Spontaneous
Trauma
Underlying lung disease
- COPD
- Lung bullae
What are some risk factors for spontaneous pneumothorax
Tall, young, males
Smoking
FHx
Marfan’s
How do you manage pneumothoraces?
Observe
Drainage
- Aspiration
- ICC with underwater seal
Pain relief and oxygen
Why might O2 help speed up the resolution of a pneumothorax?
Creates a pressure graduate for N to leave
What do you see happening in a working chest tube?
Water level moving up and down
Bubbling
Why might a chest tube have “stopped swinging”
Tube is blocked or kincked
Tube has moved
A tap has been turned
When do you take a chest tube out?
When it stops bubbling
When is surgery indicated for pneumothorax?
Non-resolving
Recurrent
What investigation finding might indicate whether you need a chest tube for an effusion?
Effusion pH
- <7.2 probably need a tube
How do you managed loculation of a effusion?
DNase
TPA
What causes pleural plaques?
Asbestosis
Previous empyema (inc TB) with blood in the pleural space
What is the lag time between asbestos exposure and mesothelioma?
30-40 years
