Pleural and mediastinal disease 1 Flashcards
What is found in the anterior mediastinum?
5
(1) Thymus
(2) Lymph nodes
(3) Thyroid
(4) Pulmonary artery
(5) Fat
What are the “Terrible Ts”?
Masses of the anterior mediastinum:
(1) Thymoma
(2) Teratoma/germ cell tumor
(3) Terrible lymphoma
(4) Thyroid tissue
What is found in the middle mediastinum?
8
(1) Pericardium
(2) Heart
(3) Great vessels
(4) Trachea
(5) Main bronchi
(6) Phrenic nerve
(7) Esophagus
(8) Lymph nodes
What is found in the posterior mediastinum?
5
(1) Neurovascular bundles
(2) Sympathetic chain
(3) Lymph nodes
(4) Thoracic duct
(5) Descending aorta
What types of masses are found in the posterior mediastinum?
Neurogenic tumors (i.e. Schwannoma)
What types of masses are found in the middle mediastinum?
Lymphoma, bronchogenic cyst
What are symptoms of mediastinal tumors?
(1) 40% experience no symptoms
(2) Cough
(3) Shortness of breath
(4) Chest pain
(5) Hoarseness
(6) Lymphadenopathy
(7) Wheezing
(8) Stridor
What are symptoms of pleural effusion?
4
(1) Cough
(2) Dyspnea
(3) Pleuritic chest pain
(4) Associated symptoms related to primary disease process
What are physical exam findings in pleural effusion?
4
(1) Dullness to percussion
(2) Decreased tactile fremitus and breath sounds due to fluid blocking transmission of breath sounds
(3) Egophony
(4) Signs of associated diseases
What is pleural fluid tested for?
5
(1) Cell count + differential
(2) Glucose, protein, LDH
(3) pH
(4) Cytology (if malignancy suspected)
(5) Gram stain + culture (if infection suspected)
What is Light’s Criteria?
Criteria to determine the source of pleural fluid (exudate vs transudate)
Exudate if any one of the following is true:
(1) Pleural fluid/serum protein > 0.5
(2) Pleural fluid/serum LDH > 0.6
(3) Pleural fluid LDH > 2/3 upper normal limit of serum LDH
What are the causes of transudative effusions?
4
Generally systemic problems
1) CHF
(2) Cirrhosis
(3) Nephrotic syndrome
(4) Hypoalbuminemia (malnourishment
What are the causes of exudative effusions?
5
(1) Infection - bacterial, fungal, Tb
(2) Malignancy - carcinoma, lymphoma, mesothelioma
(3) Inflammatory disorders - pancreatitis, asbestos, uremia
(4) Connective tissue diseases - SLE, RA
(5) Pulmonary embolism (PE)
What are the three types of parapneumonic effusions?
(1) Empyema - pus in pleural space, requires drainage
(2) Complicated - also requires drainage
(3) Uncomplicated - treated with antibiotics
How is pleural effusion treated?
(1) Treat underlying disease
(2) Thoracentesis for symptomatic relief
(3) Chest tube drainage
(4) Pleurodesis (artificially obliterate the pleural space by adhering the pleura)
