Pleural disease Flashcards
causes of pleural effusion.
imbalance between production and absorption
management of common causes of pleural effusion.
clinical history and examination
the approach to investigation of a pleural effusion.
ultrasound, CXR, CT thorax for complex ones, pleural fluid analysis (aspiration)
management of common causes of pleural effusion. if transudate
treat underlying cause
pleural malignancy is called
mesothelioma
types of effusion
transudate, exudate
causes of transudates
heart and liver problems usually, rarely pulmonary
causes of exudates
pulmonary causes eg empyema, TB, malignancy etc or some others eg pancreatitis,
types of effusion
transudate (non inflammatory), exudate (inflammatory)
causes of transudates
heart and liver problems usually eg left ventricular failure, live cirrhosis, hypoalbuminaemia, rarely pulmonary
causes of exudates
pulmonary causes eg empyema, TB, malignancy etc or some others eg pancreatitis
Pleural fluid analysis
aspiration, find pH, find dehydrogenase and glucose levels etc, inspect the fluid
if PH less than 7.2 with pneumonia, pus or blood
may need a chest drain
management of common causes of pleural effusion. if exudate
further investigations for identifying cause eg pleural biopsy or further imaging,
illnesses that cause pneumothorax
asthma, copd, interstitial lung disease, cystic fibrosis, pleural endometriosis
types of pneumothorax
primary spontaneous, secondary spontaneous, traumatic, iatrogenic, tension
presentation of pneumothorax
sudden event, chest pain or breathlessness, tall thin young men, underlying lung disease, history of biopsy/ line insertion/ mechanical ventilation
examination of pneumothorax
breathing fast, hypoxic, reduced chest wall movement, no breath sounds or reduced, hyper-ressenant note when tap, CXR
management of pneumothorax
observe if really well, aspiration if patient is well, chest drain insertion, surgery if recurrent
where does plural aspiration or drain go
2nd intercostal space midclavicular line
pleural effusion is
increase in fluid in pleural space
pneumothorax is
presence of air or gas in pleural space
mesothelioma signs
rare, aggressive. breathlessness, chest pain, weight loss, clubbing
causes of mesothelioma
inhaled asbestos fibres reach the pleura and cause inflammation provoke tumour formation. seen in plumbers, electricians, shipbuilding, power plants, boilers etc
diagnosis of pleural tumours by
ct thorax, biopsy, cxr
management of mesothelioma
treatment is limited, chemotherapy, recruitment to trials, palliative surgery sometimes, palliative care as survival is poor
pleural plaques are
benign areas of thickened tissue that forms in the pleura or lung lining. due to exposure to asbestos. usually do not require treatment
pleural fibrosis is
thickening and stiffening of the pleura that occurs as a result of pleural inflammation or exposure to asbestos
