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TCM3 > FM Radiology Case - Pleural Effusion > Flashcards

FM Radiology Case - Pleural Effusion Flashcards

1
Q

What is the purpose of the thin film of fluid in the normal pleural space?

A

Allows the visceral and parietal pleura to glide over each other during respiration

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2
Q

What is a pleural effusion?

A

Excess fluid accumulation in the pleural space

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3
Q

List the types of fluid that can accumulate in the pleural space.

A

Transudate, exudate
Pus, blood, chyle, urine
Cholesterol

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4
Q

True or false - the type of fluid of a pleural effusion can be distinguished in plain CXR.

A

False - they all look the same.

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5
Q

What is the mechanism by which transudative fluid accumulates in the pleural space?

A

Hydrostatic pressure changes, as in CHF, cirrhosis, and hypoalbuminemia

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6
Q

What is the mechanism by which exudative fluid accumulates in the pleural space?

A

Inflammation of the pleura, as in malignancy, RA, etc.

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7
Q

What is the mechanism by which pus accumulates in the pleural space?

A

Empyema from infections

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8
Q

What is the mechanism by which blood accumulates in the pleural space?

A

Trauma

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9
Q

What is the mechanism by which chyle accumulates in the pleural space?

A

Rupture of the thoracic duct

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10
Q

What is the mechanism by which urine accumulates in the pleural space?

A

Urinothorax in hydronephrosis

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11
Q

List the imaging criteria for pleural effusion on CXR.

A
  1. Homogenous density
  2. Density in a dependent position
  3. Silhouette of upper limit of density (lack of identifiable diaphragm - silhouette sign)
  4. Loss of silhouette
  5. Mediastinal shift
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12
Q

How does the density of a pleural effusion change in upright, lateral, lateral decubitus, and supine positions?

A

Upright - costophrenic angle (PA)

Lateral - anterior and posterior portions of gutter

Lateral decubitis - along the sides

Supine - along posteriorly, giving diffuse haziness on the side of the effusion

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13
Q

How does the mediastinum shift with effusion vs. atelectasis?

A

Effusion - shifts to the opposite side of the effusion

Atelectasis - pulled to the same side

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14
Q

Compare the hemithorax in pleural effusion vs. atelectasis.

A

Pleural effusion - larger hemithorax

Atelectasis - smaller hemithorax

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15
Q

Massive pleural effusion is often due to ___.

A

Malignancy

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16
Q

In ___, effusions are bilateral and more on the right.

A

CHF

17
Q

Most effusions start as ___ and can be easily missed.

A

Sub-pulmonic

18
Q

Loculated effusion is ___ unless proven otherwise.

A

Empyema

19
Q

When should loculation be considered?

A

When a density is considered to be fluid and does not correspond to anatomical location of fissures; not in the gravity dependent position

20
Q

When should a lateral decubitus film be ordered?

A

Confirm pleural effusion as with small or sub-pulmonic effusions; evaluate underlying lung; most of the time it is unnecessary

21
Q

What other imaging procedures can be of value in evaluating a pleural effusion?

A

U/S and CT

22
Q

How is U/S used to evaluate a pleural effusion?

A

Ideal for localizing loculated or small effusions for thoracentesis; can also guide thoracentesis and placement of drainage tubes

23
Q

How is CT scan used to evaluate a pleural effusion?

A

Can detect pleural masses and lung lesions not evidence in CXR; can also guide drainage placement

24
Q

When should radiologic assistance be used to tap effusions?

A

Small effusions and loculated effusions

25
Q

What is the preferred method for localization of fluid?

A

U/S

26
Q

DDx - bilateral effusion

A

Consider transudative effusions first: CHF, cirrhosis, nephrotic syndrome, kwashiorkor

27
Q

Bilateral effusions with cardiomegaly?

A

CHF

28
Q

Bilateral effusions with ascites in a person with alcohol use disorder?

A

Cirrhosis

29
Q

DDx - unilateral effusion

A

Most are exudative:

Malignancy, infections (TB, empyemas, etc.), AI disease (RA, etc.), trauma

30
Q

Massive unilateral effusion?

A

Malignancy

31
Q

Pleural effusion with apical infiltrates?

A

TB

32
Q

Pleural effusion with nodes or mass or lytic bone lesions?

A

Malignancy

33
Q

Loculated effusions?

A

Empyema

34
Q

Pleural effusion with a missing breast suggesting resection for cancer?

A

Malignancy

35
Q

Pleural effusion following chest trauma?

A

Hemothorax

36
Q

Pleural effusion in patients with mediastinal lymphoma?

A

Chylthorax

37
Q

Unique causes for left-sided effusions?

A

Pericarditis, dissecting aneurysm, rupture esophagus, acute pancreatitis

38
Q

Unique cause for right sided effusions?

A

Liver abscess

TCM3 (37 decks)

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