Disorders of pleura & mediastinum

Question 1

Pleural Effusion- Eti

Answer 1

• Transudative- heart failure

- Exudative- pneumonia & malignancy

Question 2

Pleural Effusion- Sx

Answer 2

• Dyspnea, cough, chest pain with respiration
• Contralateral tracheal deviation
• Pleural friction rub
• egophony, bronchial breath sounds
• Dullness to percussion

Question 3

Pleural Effusion- Dx

Answer 3

Thoracentisis with culture & pleura biopsy

• Exudative: Pleural fluid labs- protein, lactate dehydrogenase
• Transudates: glucose = serum, pH 7.40

Question 4

Pleural Effusion- Tx

Answer 4

Abx, chest tube, drainage

Question 5

Pleuritis- Sx

Answer 5

Localized, sharp & fleeting pain; worsened by cough, sneeze, mvmt, breathing- may refer to shoulder

Question 6

Pleuritis- Dx

Answer 6

• Identify & tx cause: viral resp. infection, effusion, thickening, penumothorx, rib fracture

Question 7

Pleuritis- Tx

Answer 7

Underlying cause

• NSAIDs
• Codeine- control cough

Question 8

Empyema- Eti

Answer 8

• Alteration of pleural membrane due to pneumonia

- Strept. pneumoniae, Staph aurea, H influ., K. pneumoniae.

Question 9

Empyema- Sx

Answer 9

• Pneumonia sx
• Pleuritic chest pain
• Failure to respond to abx
• dullness on percussion, egophony, decreased fremitus, pleural friction rub

Question 10

Empyema- Dx

Answer 10

• Thoracentesis- grossly purulent fluid

- CXR- decubitus view to determine effusion

Question 11

Empyema- Tx

Answer 11

• Abx & drainage

Question 12

Hemothorax- Eti

Answer 12

• Due to chest trauma or instrumentation

- Presence of blood in pleural space

Question 13

Hemothorax- Sx

Answer 13

Sx of pleural effusion- dullness to percussion, decreased breath sounds, dyspnea, chest pain

Question 14

Hemothorax- Dx

Answer 14

• Thoracentesis- presence of gross blood in pleural space

Question 15

Hemothorax- Tx

Answer 15

• Observation

- Thoacostomy tube to drain, quantify, reduce risk of fibrothorax & reduce hemorrhage

Question 16

Superior vena caval syndrome- Eti

Answer 16

Obstruction to SVC commonly due to malignancy, mediastinitis of unknown origin or secondary to Tb, histo,

Question 17

Superior vena caval syndrome- Sx

Answer 17

• Swelling of neck, face, upper extremity
• Bending or lying accentuates symptoms
• Brawny edema, cyanosis of face, neck, arms
• Elevated venous pressure in arm, normal in leg

Question 18

Superior vena caval syndrome- Dx

Answer 18

• CXR/ CT

- Brachial venography

Question 19

Superior vena caval syndrome- Tx

Answer 19

• Lifestyle modification
• Tx underlying sx
• Anticoagulation

Question 20

Pneumothorax- Eti

Answer 20

• Tall, thin males between 10 & 30
• Fam hx & smoking
• Due to trauma, lung disease

Question 21

Pneumothorax- Sx

Answer 21

• Acute onset unilateral chest pain & dyspnea
• Decreased tactile fremitus, hyperresonance, diminished breath sounds
• Tension pneumothorax: marked tachycardia, mediastinal or tracheal shift, hypotension

Question 22

Pneumothorax- Dx

Answer 22

CXR: Visceral pleural line

Question 23

Pneumothorax- Tx

Answer 23

• Aspiration of air through catheter, chest tube

- Supplemental O2, tx cough & chest pain

Question 24

Mediastinal tumor- Eti

Answer 24

• Neoplastic, infections, traumatic & CV disorders

- Most commonly in anterior & middle compartment

Question 25

Mediastinal tumor- Sx

Answer 25

• Non-specific

- Insidious onset of retrosternal chest pain, dysphagia, dyspnea

Question 26

Mediastinal tumor-Dx

Answer 26

CXR or CT

Question 27

Paraneumonic effusion- Eti

Answer 27

• Uncomplicated- free flowing sterile exudates,
• complicated- large, inflammatory invasion of pleural space
• Empyema- gross pleural space infection

Question 28

Paraneumonic effusion- Tx

Answer 28

Tube thracostomoy