Disorders of the Pleural Space, Mediastinum, and Chest Wall Flashcards
What is the presentation of pleural effusion?
SOB
Orthopnea
PND
Chest pain (pleuritic or ‘heaviness’)
Cough- usually dry
What will be found on physical exam when working up pleural effusion?
Can be normal if PE is small
Dullness to percussion (over fluid)
Diminished breath sounds
Decreased tactile fremitus
E –> A on egophony (over fluid)
+/- Pleural friction rub
What work-up component is both diagnostic and therapeutic in a pleural effusion?
Thoracentesis
Based on Light’s criteria, a Pleural:Serum Protein ratio < 0.5 would suggest which type of PE?
Transudate
> /= 0.5 would be exudate
What is a Transudative plueral effusion?
Decreased oncotic or increased hydrostatic pressure
- Too much fluid or too few proteins in the fluid (think fluid overload due to CHF, liver failure, or CKD)
What is an exudative pleural effusion?
Inflammation –> increased capillary permeability “leaky capillaries”
Primarily caused by infectious agents or malignancy
What is the treatment for PE?
Treat underlying cause
Therapeutic thoracentesis
+/- chest tube
+/- surgical management
What is the preferred imaging in work-up of a hemothorax?
CT
Define pneumothorax?
Accumulation of air in the pleural space
What connective tissue disorder is associated with a high risk of pneumothorax?
Marfan’s
What is a pleurodesis and when is it indicated?
Tacking up the lung, usually with abrasive materials such as talc, or doxycycline
Used for recurrent, bilateral, failure of chest tube
What are some common presenting symptoms in mediastinal masses?
Obstructive respiratory symptoms
Stridor
Recurrent bronchitis or PNA
Chest pain, weight loss, or dysphagia
+/- symptoms of underlying disorder
What is the diagnosis work-up for pneumomediastinum?
CXR (AP view)
CT to confirm, assess extent or look for cause
What is the treatment for pneumomediastinum?
Most resolve on their own - air reabsorbs
Symptomatic
