Lecture 14: Pleural and Chest Wall Disease Flashcards
what is pleural effusion
fluid in pleural space
what is pneumothorax
air in the pleural space
what would you see in examination of pneumothorax
- raised respiratory rate
- reduced breath sounds
- increased percussion note
- reduced expansion
what is iatrogenic pneumothorax
pneumothorax after a procedure, eg after inserting pacemaker or central line or biopsy
what is traumatic pneumothorax
pneumothorax due to trauma eg resuscitation or a fight
features of primary pneumothorax
- occurs in healthy young tall males
- more common in smokers esp. cannabis smokers
- tension rarely occurs
- won’t always need drain or admission
features of secondary pneumothorax
- already have known lung disease
- mostly will need a drain
- tension is more common
how big is a large pneumothorax
> 2cm from hilum
what is the follow up of primary peumothorax
- 54% recurrence in first 4 years
- 20-30% in first 2 years
- recurrent primary leads to surgical or medical thoracoscopy and pleurodesis
what is the follow up of secondary pneumothorax
attempt pluerodesis after the first episode as recurrence rate is high
what advice is given after a pneumothorax
- no deep sea diving
- no air travel after a week
- coast guards, naval officers, air force etc need to change jobs
- high altitude sports and travel are discouraged
- stop smoking
symptoms of pleural effusion
- SOB
- cough
- pleuritic chest pain
- reduced breath sounds
- dull to percussion on examination
what are the commonest causes of pleural effusion
- heart failure
- pneumonia
- malignancy
what are risk factors for pleural infection
- diabetes
- immunosuppression
- alcohol / IVDU
- poor oral hygiene
- iatrogenic eg previous pleural procedure
- trauma
- recent hospitalisation
what are predictors of a worse pleural effusion outcome
- pH < 7.2
- high LDH
- positive culture
- loculations seen on ultrasound or CT
