Diseases of the Pleura Flashcards
What is a pleural effusion?
Abnormal collection of fluid in the pleural space
What are the symptoms of pleural effusion?
Dependent on cause and volume of fluid Asymptomatic Increasingly breathless Pleuritic chest pain Dull ache Dry cough Weight loss Malaise Fever Night sweats
What are the signs of pleural effusion?
Decreased expansion Stony dullness to percussion Breath sounds Vocal resonance Clubbing Tar staining Cervical lymphadenopathy Increased JVP Trachea away from large effusion Peripheral oedema
What are the transudate causes of pleural effusion?
Imbalance of hydrostatic forces influencing the formation and absorption of pleural fluid, usually bilateral
Normal capillary Permeability
COMMON: LV failure, Liver cirrhosis and ascites, Hyponalbuminaemia, Peritoneal dialysis
LESS COMMON: Hypothyroidism, Nephrotic syndrome, Mitral stenosis, Pulmonary embolism
RARE: Constrictive pericarditis, Ovarian hyperstimulation syndrome, Meig’s syndrome
What are the exudate causes of pleural effusion?
Increased permeability of pleural surface and or local capillaries, usually unilateral
VERY COMMON: Malignancy, Parapneumonic
LESS COMMON: Pulmonary embolism, Rheumatoid arthritis, Autoimmune disease, Benign asbestos effusion, Pancreatitis, Post MI
RARE: Yellow nail syndrome, Drugs
What is the cut off for classifying transudate or exudate?
Less than 30g/l transudates
More than 30g/l exudates
What are the investigations for pleural effusion?
Investigate if unusual features or failure to respond to appropriate treatment
Confirm presence with CXR - must be at least 200ml fluid
Contrast CT of thorax
Pleural aspiration and biopsy
Thorascopy
What are the treatments for pleural effusion?
Directed at cause - chemo, antituberculosis, corticosteroids
Repeated pleural aspiration 1-1.5L at a time
Pleurodhesis - 4th intercostal space mid axillary line drain no faster than 500ml/hour
Drain to dryness check with CXR
What is a pneumothorax?
Presence of air within the pleural cavity
Breach of visceral of parietal pleura with entry of air, lung collapses away from chest wall because of elastic reoil
What are the causes of a traumatic pneumothorax?
IATROGENIC - pleural aspiration/biopsy, subclavian vein cannulation, acupuncture
NON-IATROGENIC - penetrating chest injury, blunt chest injury
What are the causes of primary spontaneous pneumothorax?
No clinically apparent disease
Weight of lung inducing development of apical blebs that rupture
What are the causes of secondary spontaneous pneumothorax?
Pre-existing lung disease COPD Asthma Pneumonia TB Cystic fibrosis Fibrosing alveolitis Sarcoidosis Histiocytosis
What are the symptoms of a pneumothorax?
Asymptomatic
Acute breathlessness, worsening breathlessness
Pleuritic chest pain
Extreme dyspnoea
What are the signs?
May be none if small
Surgical emphysema if significant air leak
NON TENSION - trachea deviated to affected side, decreased expansion, hyper resonant and absent or decreased breath sounds
TENSION - Trachea deviated away from affected side, Haemodynamic compromise, increased JVP
What is the treatment for a tension pneumothorax?
Cannula in 2nd intercostal space and then insert chest drain
