Fibrothorax Flashcards
(9 cards)
1
Q
What is fibrothorax?
A
- Localised or diffuse irreversible fibrotic transformation of pleura
- Pleural thickening > 5mm extending to major portions of hemithorax
- Encases lung and restricting expansion, impairs respiratory function
2
Q
What are the examination findings/signs of fibrothorax?
A
- +/- Trachea deviation towards affected side (in volume loss)
- Shrinking of hemithorax - reduced chest expansion over affected side
- Dullness to percussion
- Decreased vocal resonance
- Reduced breath sound but still present
- +/- pleural friction rub
3
Q
What are the differential diagnoses for dull percussion and reduced vocal resonance?
A
- Lung collapse
- Collapse with effusion
- Longstanding effusion with trapped lung
- Mesothelioma
4
Q
What are the causes of fibrothorax?
A
Unilateral
1. Tuberculosis
2. Empyema
3. Haemothorax
4. Trauma
Bilateral
5. Asbestosis
6. Connective tissue disease
7. Drug-induced
8. Uraemia
5
Q
What is the complication of fibrothorax?
A
Diffuse pleural thickening causes marked reduction in lung volume and hypoventilation of affected lung
6
Q
What are the investigation for fibrothorax?
A
- Lung function test - restrictive pattern
- CXR - malignancy or active PTB
- CT thorax - pleural thickening and fibrothorax
- Lung biopsy
7
Q
How would you manage fibrothorax?
A
- Treat underlying cause
- Pulmonary rehabilitation
- VATS or open decortication
8
Q
What are the indications for decortication surgery in fibrothorax?
A
- Significant respiratory symptoms
- Significant restriction vital capacity < 60%
- Trapped lung
- Chronic non-resolving empyema
- Failure of conservative treatment - antibiotics and pleural drainage of empyema
9
Q
Complications of decortication
A
- Prolonged air leak and bronchopleural fistula
- Bleeding
- Post-operative infection
- Respiratory failure
- Failure of lung re-expansion
- Persistent pain
