Lecture 11: Pleural disease

Question 1

Pleural Fluid:

Answer 1

Transudate

• CHF
• cirrhosis
• nephrotic syndrome

Exudate

• Neoplastic disease
• Infectious Diseases
• Pulmonary Emboli
• Gastrointestinal disease e.g. pancreatic disease
• Collagen Vascular Diseases
• Everything else

Question 2

Empyema

Answer 2

• Collection of pus in the pleural space, often loculated.
• Fluid characteristics:
  
  • usually thick, green/yellow/brown
  • may be foul smelling
  • pH < 7.20, WBC’s > 10,000/mm3
• Requires drainage and breakdown of all loculations.
• Mortality > 25% with delayed diagnosis.

Question 3

Malignant Effusions: Mechanisms

Answer 3

• incr pleural permeability
• Obstruction of pleural lymphatics (pleural and/or mediastinal)
• Postobstructive pneumonitis
• Thoracic duct interruption (chylothorax)
• Hypoproteinemia
• Postradiation therapy

Question 4

Malignant Effusions

Answer 4

• Metastatic disease accounts for most malignant pleural effusions.
• Site of origin: lung (men), breast (women), lymphoma, gut, ovary
• Exudative fluid
• Diagnosis by fluid cytology or pleural biopsy.