Pleural disease Flashcards
Describe primary spontaneous pneumothorax
Pneumothorax which present without precipitating external event in the absence of clinical lung disease
Discuss risk factors for deveopment of primary spont pneumothorax
-Male
-Asthenic body habitus/subpleural blebs
-Drug use (cigerettes, MJ, Cocaine)
-Increased transpulmonary pressure (Valsalva, diving, military flying
?Genetic
Define secondary spont pneumothorax
Defined as a spontaneous pneumothora that presents as a complications of an underlying lung disease
List Aetiology of secondary spont pneumo
COPD and CA are the most common cause in Australia
Airway disease
- CF
- Asthma
- COPD
INfection
- PJP
- TB
- Necrotizing pneumonia
Congenital
Interstitial
- Sarcoid
- Langerhans cell granulomatosis
Connective tissue -Marfans -Ehlers Danlos Juvenile idiopathic arthirtis -polymyositis
Malignancy
- primary
- mets
Airway obstruction
-foreing body
Thraocic endometriosis
Discuss estimation of size of pneumothorax
BTS - >2cm from rim to wall at the level of the hilum
ACCP estimates the volume by measuring the distance from the lung apex to the cupola - A visible rim of >3cm is considered a large pneumo
Colins method (a + b + c)
- A is the max apical interplural distance
- B is the interpleural distance at the midpoint of upper half o lung
- C is the interpleural distance at the midpoint of the lower half of the lung
Discuss management of pneumothoax
1) Decide whether patient is stable or unstable Stable if -RR <24 HR <120 and >60 -Nromal systolic -RA spo2 >90% -Speaking in whole sentences
2a) If unstable immediate drainage
2b) if stable are any of the following preent
- recurrence of pneumothorqax
- another indication for drainage (e.g effusion)
3a) if another indication for drainage drain
3b) if nil other indication for draiange access size on chest radiography
4a) small pneumo using either BTC or AMCC
- Observe with or without supplental o2 for 6 hours
- if stable and reasonable patient who can return cna be dsicharged home for repeat 24 hour CXR
- If not resolved at 24 hours for ICC
4b) n if large
- aspirate until resistance is felt or until 4 L of air removed
- If nil resistance or >4 L of air need ICC
- Otherwise repeat CXR at 4 hours - if improved repeat CXR again in 2 hours and as above
- if not for ICC
Discuss DDX of pleural effusions
Transudates
- CCF
- Chirrosis
- Nephrotic syndrome
- hypoalbuminemia
- myxoedema
- peritoneal dialysis
- glomerulohephritis
- SVC obstruction
- PE
Exudates
1) infection
- bacteral pneumonia
- lung abcess
- bronchiectasis
- TB
- biral illness
2) Neoplasms – low ph and glucose
- Primary lung cancer
- Mesothelioma
- Pulomnayr or pleural mets
- Lymphoma
3) Connective tissue
- RA
- SLE
4) Abdominal or GI
- pancreatitis - amylase
- subphrenic abcess
- oeosopahgeal rupture – increase amylase
- abomdinla surgery
5) Misc
- Pulmonary infarct
- uremia
- drug reaction
- post partum
- chylothorax – high triglycerides
Define parapneumonic effusions
A parapneumonic effusions refers to the accumulation of fluid in the peural space in the setting of an adjacent pneuonia
- An uncomplicated or simple parapneumonic effusion referes to a free flowing effusion that is steril
- complicated parapneumonic effusions refers to an effusions that has been infected with bacteria or other micro-organisms
- An empyema refers to a collection of pus within thr pleural space
Ph of effusion can be used to indicate need for drainage vs ABs and conservative- pH <7.2 needs to be drained
- A complex effusion refers to an effusion with internal loculations
Describe primary spontaneous pneumothorax (PSP) study
Investigating conervative vs intervention for large primary spont pneumo
Exclusion
- previosu spont pneumo
- secondary pneumo
- bilteral pneumo
- co-exisiting haemo
- hd instability
- patient unlikley to follow-up
- pregnancy
98.5% resolution in 8 weeks compared to 94.4% in conservative. Non inferior
Time to resolution not statistically different
Conservative management resulted in fewer hospital days, less surgery and less adverse events
