Pleura Flashcards
What are the 2 layers of pleura?
Visceral pleura
Parietal Pleura
How much fluid is there inbetween the pleural layers?
2-3ml
Is the pressure in the pleura positive or negative?
Negative
Where does the pleura extend?
Above the first rib
Goes further down also
What is a pleural effusion?
This is an abnormal collection of fluid in the pleural space
What does the symptoms of pleural effusion depend on?
The cause of the effusion
And the volume of fluid that has accumulated
What are the symptoms of pleural effusion?
Increasing breathlessness Pleuritic chest pain Inflammation Dull ache Dry cough Weight loss Malaise Fevers Night Sweats
What is pleurisy?
The inflammation of the pleura
What are the signs of pleural effusion?
Chest pain on affected side Less expansion Stony dullness to percussion Vocal resonance Finger clubbing Cervical lymph node swelling Trachea has been shifted (especially if there is large effusion) Peripheral oedema
What are the 2 types of pleural effusion?
Transudates
Exudates
What is a transudate effusion?
This is where there is an imbalance of pressures
Is transudate usually bilateral or unilateral?
Bilateral
What are the very common side effects of transudate effusion?
Left ventricular failure
Liver cirrhosis
What is a exudate effusion?
This is when there is an increased permeability of the pleura or capillaries
Is exudate usually bilateral or unilateral?
Usually but not always unilateral
What causes an exudate pleural effusion?
There is an inflammatory reaction in the lung causing vasodilation so fluid and proteins can leak through into the pleural cavity
How much fluid is required in the pleura before it can be detected on a CXR?
200ml of fluid
What is mesothelioma?
A disease in which malignant cells are found in the pleura or the peritoneum
What is the peritoneum?
The membrane surrounding the heart
What is mesothelioma caused by?
Asbestos exposure
What is the prognosis of mesothelioma?
Less than 2 year survival rate
How does asbestos cause mesothelioma?
The fibers in asbestos can cause inflammation and scarring which can lead to the development of cancer cells
What are the treatment options for mesothelioma?
Surgery - involves the removal of all or part of the pleura
Chemotherapy
Radiotherapy
What is empyema?
Condition in which pus accumulates in the area between the lungs and the inner surface of the chest wal
What is pus composed of?
Filled with immune cells
Dead cells
Bacteria
Can pus in the lungs be coughed back up?
No
How do you get rid of pus in the lungs?
Needs to be drained by a needle or surgery
After what condition does empyema normally follow?
Pneumonia
With empyema what will a CXR look like?
Pleural effusion
When will a diagnosis for empyema be confirmed?
When the fluid drained from the lungs appears to be yellow
What are the other names for empyema?
Pyothorax
Purulent Pleuritis
What is pneumothorax?
Defined by the presence of air within the pleural cavity
How does a pneumothorax occur?
Their a breach of the pleura which allows the entry of air
Due to the loss of relationship between the pleura
When can a pneumothorax be asymptomatic?
If the patient is young and fit and the pneumothorax is small
What are the symptoms of pneumothorax?
Pleuritic chest pain
Breathlessness
Sudden deterioration
Decreased chest expansion on examination
The trachea can be deviated away from the midline
What is a primary spontaneous pneumothorax?
No clinically apparent disease before hand
Completely random
Is primary spontaneous pneumothorax more common in men or woman?
More common in men
What is secondary spontaneous pneumothorax?
When there is pre-existing lung disease
In what % of patients if COPD present in secondary spontaneous pneumothorax?
30-50%
What % of asthmatics develop secondary spontaneous pneumothorax?
0.8% of asthmatics
What conditions are present in patients before they develop secondary spontaneous pneumothorax?
COPD Asthma TB Cystic Fibrosis Sarcoidosis Secondary pneumothorax can be brought on by almost any lung disease
What is traumatic non-iatrogenic pneumothorax?
Caused by a penetrating chest injury e.g stabbing or gun wound
Blunt chest injury (rib fractures, bronchial rupture)
I.e was a complete accident
What is a traumatic iatrogenic pneumothorax?
When the penumothorax is caused by something that could have been completely avoided
What could cause a traumatic iatrogenic pneumothorax?
Pleural aspiration
Sub-clavian vein cannulation
Lung, liver, breast, renal biopsy
Acupuncture
What is classed as a small pneumothorax?
<2cm
What is classed as a large pneumothorax?
> 2cm
Where is a chest drain inserted?
4th intercostal space
How is a small non-breathless pneumothorax treated?
Observe overnight Repeat CXR If no change hole has sealed Discharge Advise no vigorous movement Return if it gets worse
How is a small breathless pneumothorax treated?
Second intercostal space drain - suck out the air to re-inflate the lung
Aspirate until can feel the surface of the lung beneath the chest wall
How is a secondary pneumothorax treated?
Insert a chest drain at intercostal space 4
Where is the chest aspirated form anatomically?
2nd intercostal space
Mid-clavicular line
When should a pneumothorax have ideally re-inflated by?
48 hours
How is pneumothorax treated by surgery?
With the use of talcum powder
What is asbestos?
Highly fibrous naturally occurring mineral
What are the 3 types of asbestos?
White
Brown
Blue
Which asbestos is most dangerous to human health?
Blue
Give examples of occupations that involve asbestos exposure
Boiler men Engineers Electricians Plumbers Ship builders
When does disease occur after asbestos exposure?
20-40 years
What is mesothelioma?
A form of pleural malignancy
What % of cases of mesothelioma are due to asbestos exposure?
80%
What are the symptoms of mesothelioma?
Chest pain
Weight loss - associated with cancer in general
Breathlessness
Usually unilateral
How is mesothelioma seen on a CXR?
Thickening of the pleura
If a mesothelioma is suspected on CXR what is the next step?
Send the patient for a CT scan
