pleural Flashcards
visceral pleura lines the
lungs
parietal pleura lines the
mediastinum, diapghragm and chest wall
Costal & peripheral diaphragmatic pleura innervated by _______. Pain referred to __________
Costal & peripheral diaphragmatic pleura innervated by intercostal nerves. Pain referred to chest wall.
Central diaphragmatic pleura: innervated by ________ Pain referred to ___________
Central diaphragmatic pleura: innervated by phrenic nerve. Pain referred to ipsilateral shoulder.
how is the mechanical coupling of lungs against throacic wall maintaines?
by preventing gas and liquid accumulating
transudate
plasma ultrafiltrate due to altered starling forces
what sterling forces are altered in pleural effusions that cause transudate
- increase in hydrostatic pressure in the capillary - decrease in oncotic pressure in the capillary
exudate
protein-rich fluid results from increased capillary leakage secondary to inflammation or disease of pleural surface
major etiology of transudate (4)
- CHF - nephrotic syndrome - cirrhosis - atelectasis
major etiology of exudate (5)
- tumor - pneumonia - TB - pulmonary embolism - collagen vascular disease
do effusions cause pain? what is the pain?
effusions do not cause pain - it is a sign of parietal pleura irritation by the process causing the pleural effusion
what are some of the physical signs of an effusion?
- decrease in chest excursion - decrease in tactile fremitus - decrease or absent sounds over the effusion
loculated pleural effusion (3)
- empyema - hemothorax - malignancy
what do you want to evaluate when considering pleural effusion?
- protein - LDH
pleural fluid protein/ serum protein > 0.5
exudate
pleural fluid LDH/serum LDH >0.6
exudate
pleural fluid protein < 2.9
transudate
leading cause of pleural effusion (2)
- CHF: transudate - pneumonia: exudate
hepatic hydrothorax
caused by cirrhosis of the liver leading to transudative fluid moving to pleural space
parapneumonic effusion
sterile exudate
empyema
organisms or pus
what does it mean when we see tumors in the pleural space?
poor prognosis
chylothorax how does the exudate look like?
pleural effusion due to leakage of chyle due to lymphoma - exudate= milky and has high triglycerides
how do you treat transudate? exudate?
- transudate- treat underlying cause - exudate- might require further intervention such as in the case of a hemothroax
small pneumonia
effusion<10 mm
large effusion
> 10mm and thoracentesis is indicated
pneumothorax will present as _______ to percussion and the degree of collapse depends on
present as hyperresonance and the degree of collapse depends on size of PTX and elasticity of lung
- trachea shifted to contralateral - compressed left lung - mediastinum shifted to contralateral side - diaphragm depressed and inverted contour
tension pneumothorax
primary simple pneumothorax
spontaneous caused by small subpleural blebs that rupture
secondary complicated pneumothorax
occurs in underlying disease like COPD
iatrogenic pneumothorax
most common; puncture of the visceral pleura during invasive procedures
loculated pleural effusion
tuberculosis- exudate lymphocytic
