Pleural disease Flashcards
What is the pleura ?
Smooth, thin membrane around the lungs
What is the outer layer ?
Parietal pleura
What is the inner layer ?
Visceral pleura
What cells are in the pleural fluid ?
Macrophages
Lymphocytes
Mesothelial cells
What is the plural pressure ?
Subatmopheric
-3 to -5 cm of water
Apex-base
What is a pleural effusion ?
Collection of fluid in the pleural space
What are the signs of pleural effusion ?
Decreased expansion
Stony dullness on percussion
Decreased breath sounds
Decreased vocal resonance
What is the imbalance in a pleural effusion ?
Imbalance between production and absoption
What are the types of effusion ?
Transudate
Exudate
What is a transudate effusion ?
Non-inflammatory
What are some common causes of transudate effusion ?
Left ventricular failure
Liver cirrhosis
What is an Exudate effusion ?
Inflammatory
What are some common causes of exudate effusions ?
Malignancy
Parapneumonic effusions
Empyema
TB
What is the protein content of exudate ?
3g/dl or more
What is lights criteria ?
Protein: pleural fluid/ serum fluid ratio >0.5
LDH: pleural fluid/serum fluids ratio >0.6
Pleural fluid LDH >2/3rd ULN serum LDH
What are the investigations of pleural effusions ?
US: more sensitive than CXR
mark site for aspiration
assess pleura, bedside
CXR: accessible
easy to interpret
CT thorax: complex effusions
vascular and mediastinal structures
How is pleural fluid analysed ?
Aspiration
pH, biochemistry, microbiology and pleural biopsy
What is the management of a pleural effusion ?
pH <7.2 with pneumonia, pus or blood may need a chest drain
Transudate: treat the underlying cause, may not need CT imaging
Exudate: further investigations and pleural biopsy
What is a pneumothorax ?
Collection of air in the pleural space
What are the types of pneumothorax ?
Primary spontaneous Secondary spontaneous Traumatic Latrogenic Tension
How is a pneumothorax presented ?
Sudden event Chest pain or SOB Tall thin young men Underlying lung disease History of biopsy/ line insertion/ mechanical ventilation
What are the signs found on examination of a pneumothorax ?
Tachypnoeic- breathing fast
Hypoxic
Reduced chest wall movement and reduced or no breath sounds
Examination may be normal
How is a pneumothorax diagnosed ?
CRX
US
CT thorax
How is a pneumothorax managed ?
Aspiration: >2cm
Chest drain insertion
Surgery: recurring events, unresolving
Where is a pleural drain put ?
2nd intercostal space midclavicular line
What type of pleural tumours are rare ?
Benign
What is a pleural malignancy ?
Mesothelioma
What is mesothelioma ?
Rare, aggressive form of cancer in the pleura
What can cause mesothelioma ?
Exposure to asbestos fibres
What are the symptoms and signs of mesothelioma ?
Breathlessness Chest pain Weight loss Clubbing Signs of pleural effusion
How is mesothelioma diagnosed ?
CXR: pleural effusion, pleural based mass#
CT thorax and biopsy: needed to stage
Thickened pleura, pleural nodules or masses, pleural plaques, an effusion, soft tissue infiltration
What is the management of mesothelioma ?
Limited, incurable
Treat effusion
Chemotherapy
Palliative surgery
