Disorders of the Pleura Flashcards
Abnormal accumulation of fluid in the pleural space. It is not a disease itself but a sign of a disease.
Pleural effusion
Direct infection of pleural space (grossly purulent/turbulent)
Empyema
Chest trauma with gross blood
Hemothorax
Due to high cholesterol
Chyloform
Circulatory system fluid due to either an increase in hydrostatic and/or oncotic pressure NOT by inflammation and not due to local pleural disease
Transudate
What is the most common cause of transudate?
CHF (>90%)
Other than CHF, what can cause transudate?
Nephrotic syndrome, cirrhosis, atelectasis
PE’s usually result in pleural effusions of ____
Exudate
Occurs when local factors increase vascular permeability (ex. infectious process)
Exudate
Any fluid that filters from circulatory system into areas of inflammation (contains an increase in plasma proteins, WBCs, platelets +/- RBCs)
Exudate
What is exclusive to exudates?
Lights criteria: To be considered an exudate it must have ONE of lights criteria
Pleural fluid protein:Serum protein ratio for exudate with light’s criteria
> 0.5
Pleural fluid LDH:Serum LDH ratio for exudate with light’s criteria
> 0.6
Pleural fluid LDH must be greater than _____ upper limit of normal LDH
2/3
Asymptomatic symptoms with dyspnea and “pleuritic” chest pain*** and cough
Pleural effusion
On PE, a pleural effusion will have _____ tactile fremitus, _____ breath sounds, and _____ to percussion
Decreased
Decreased
Dullness
In extreme cases, pleural effusions can cause lung collapse or mediastinal shift to _______ side
contralateral
How do you diagnose a pleural effusion?
CXR
How much fluid can be seen on a PA CXR?
> 175cm
Blunting of costophrenic angles with or without loculations
Menisci
Pleural effusions are _____ for menisci on x-rays
Positive
What film is the best type of film to check for a pleural effusion?
Lateral decubitus
Why is a lateral decubitus film best to diagnose a pleural effusion?
Detects smaller effusions, differentiates location and makes it so you can tell the difference between new effusions or scarring
How do you confirm empyema?
CT scan
What causes loculations?
pleural adhesions
How do you manage a pulmonary effusion?
Treat underlying condition
Thoracentesis
Thoracentesis for pleural fluid drainage
What is a pleurodesis?
Gets rid of pleural space to prevent chronic pleural effusions. Obliteration of pleural space with talc and bleomycin.
What is the gold standard treatment for a pleural effusion?
Thoracentesis
Do not remove more than ____L of fluid during a thoracentesis in one procedure
1.5L
If the pleural fluid pH is less than 7.2
empyema
____ are associated with leaky capillaries from infection, malignancy, and trauma
Exudates
______ are associated with increased hydrostatic or decreased oncotic pressure; examples include CHF, atelectasis and renal or liver disease
Transudates
An infection within the pleural space
Empyema
Empyema requires a thoracentesis and ___?
Antibiotic therapy
_____ Pleural effusions resolve when underlying causes are treated
Transudate
Air within the pleural space
Pneumothorax
What causes the lung to collapse in a pneumothorax?
Positive pleural pressure
What are the three types of pneumothorax?
Spontaneous
Traumatic
Tension
What are the two types of spontaneous pneumothorax?
Primary and secondary
atraumatic and idiopathic
No underlying disease; mainly affects tall, thin men 20-40 (Max you’re screwed), smokers, and those with a family history
Primary spontaneous pneumothorax
Underlying lung disease (COPD, asthma), occurs without trauma
Secondary spontaneous pneumothorax
Can be caused by iatrogenic causes - CPR, thoracentesis, PEEP, subclavian lines or other trauma
Traumatic pneumothorax
When + air pressure pushes lungs, trachea, and the heart to the contralateral side
Tension pneumothorax
Which type of pneumothorax is immediately life threatening?
Tension pneumothorax
How do you manage a tension pneumothorax?
Needle aspiration followed by chest tube thoracostomay
What are the clinical manifestations of a pneumothorax?
Chest pain (usually pleuritic and unilateral)
Non exertional in onset
Dyspnea
A pneumothorax shows ____ hyper-resonance, _____ fremitus, and ______ breath sounds
Increased hyper resonance
Decreased remits
Decreased breath sounds
How do you diagnose a pneumothorax?
CXR with expiratory view
What does a CXR of a pneumothorax show?
Companion lines*, decreased peripheral markings, and a deep sulcus
How do you manage a pneumothorax?
Observation if small
Chest tube placement
Needle aspiration
How small does a pneumothorax need to be for it to close spontaneously?
Less than 20%
If its a tension pneumothorax, what do you do first?
Needle aspiration
Where do you place the needle for a needle aspiration of a tension pneumothorax?
2nd intercostal space in the midclavicular line
What do you do once you perform a needle aspiration on a patient with a tension pneumothorax?
Place a chest tube
Why is a tension pneumothorax so dangerous?
It compromises the cardiovascular system
