Lecture 18: Pleural Space Disorders (Specht) - what was covered in class

Question 1

pleural effusion

Answer 1

accumulation of fluid in pleural sapce

Question 2

hydrostatic and oncotic P effect on pleural fluid***

Answer 2

hydrostatic and oncotic pressures in pulmonary circulation favor form. of pleural fluid at parietal pleural surfaces and absorption at visceral surfaces (conditions that alter this balance result in accum. of fluid)

Question 3

See equation on pleural effusion on 1st slide***

Answer 3

:)

Question 4

CS of pleural effusion

Answer 4

• usually none with mild effusion
• tachypnea, inspiratory dyspnea, orthopnea (shortness of breath when lying flat), open mouth breathing, cyanosis
• dec. lung sounds w/ percussible “fluid line”

Question 5

diagnostic tests for pleural effusion

Answer 5

• rads
• thoracocentesis with cytology +/- culture
• therapeutic thoracocentesis in emergency
• O2, calm patient

Question 6

tx of pleural effusion

Answer 6

supportive care:
-intermittent thoracocentesis, chest tubes
-O2
diuretics?
-maintain hydration

Question 7

transudate v. exudate

Answer 7

exudates have higher protein content and/or cell count than transudates

Question 8

non-septic exudates usually consist of:

Answer 8

variable cell types including activated macs/lymphs and/or non-activated neuts, eos

Question 9

septic exudates

Answer 9

• have extremely elevated cell counts
• degenerate neuts predominate
• bacteria present
• foul odor if anaerobes present
• sulfur granules w/ Nocardia or Actinomyces

Question 10

Aerobic and anaerobic cultures possible in pleural effusion?

Answer 10

Yes

Question 11

Chylous effusion characteristics*

Answer 11

• hallmark: triglyceride conc. higher in chylous effusion than in serum**
• moderate protein and variable cell counts
• grossly white/turbid

Question 12

predominant cell type in ACUTE chylous effusions

Answer 12

lymphocytes

Question 13

predominant cell type in CHRONIC chylous effusions

Answer 13

neuts and macs, +/- plasma cells

Question 14

causes of chylous effusion (chylothorax)

Answer 14

• results from leakage of lymph from thoracic duct

- usually idiopathic, but can occur with trauma, neoplasia, cardiac disease, HW, lung torsion, diaphragmatic hernia

Question 15

chylothorax tx

Answer 15

• resolve cause of lymphatic obstruction if possible

- idiopathic: intermittent thoracocentesis, rutin, sx

Question 16

chylothorax prognosis

Answer 16

generally guarded to poor

Question 17

only tumor that readily exfoliates into effusions*

Answer 17

lymphoma

Question 18

remember: inflammation causes reactive mesothelial cells to appear dysplastic like malignancy. Therefore, there are multiple criteria of malignancy***

Answer 18

:)

Question 19

T/F: neoplasia in thorax can result in any type of effusion

Answer 19

T

Question 20

if neoplasia is suspected, but definitive dx is not possible with cytology, do a:

Answer 20

biopsy

Question 21

cytology of pleural effusion involves:

Answer 21

• measurement of total protein
• total cell count
• assessment of cell morph

Question 22

transudates vs. modified transudates

Answer 22

• transudates have lower protein content and nucleated cell counts.
• transudates have primarily mononuclear cells (macs, lymphos, mesothelial cells)
• neuts may be present in modified transudates