Pleural disease Flashcards
What are the types of pleural disease?
Effusion
Pneumothorax
Empyema
Haemothorax
Mesothelioma
What is pleural effusion?
Excess fluid in pleural space
What are the 2 types of pleural effusion?
Transudates
Exudates
What are the features of transudate pleural effusion?
Non inflammatory
Low protein
Imbalance of hydrostatic forces influencing production and absorption of pleural fluid
What causes transudate pleural effusion?
Hypalbuminaemia
Cardiac failure
Liver failure
Renal failure
What are the features of exudate pleural effusions?
Inflammatory
High protein
Increased permeability of pleural surface or local capillaries
What are the cause of exudate pleural effusion?
Malignancy
Parapneumonic effusions
Empyema
Tuberculosis
What are the symptoms of pleural effusion?
SoB
Cough
Pleuritic chest pain
What are the signs of pleural effusion?
Decreased breath sounds
Decreased tactile fremitus
Decreased chest expansion
Dull percussion
Tracheal deviation
What is the criteria for pleural effusion?
Light’s criteria
What is Light’s criteria?
Protein: pleural fluid/serum fluid ratio >0.5
LDH: pleural fluid/serum fluid ratio>0.6
Pleural fluid LDH>2/3 ULN serum LDH
What are the investigations for pleural effusion?
Ultrasound
CXR
CT thorax
Aspiration- analyse biochemistry, microbiology and cytology
What is pneumothorax?
Collection of air in pleural space
What are the symptoms of pleural effusion?
Chest pain
SoB
Tachypnoea
What are the signs of pleural effusion?
Hype resonant percussion
Reduced breath sounds
Reduced chest expansion
Deviated trachea
What is the management of pneumothorax?
- Observe
- Aspiration- 2nd intercostal space, midaxillary line
- Chest drain
- Surgery
What is pleurodesis?
Talc purdage used on pleural space to prevent further collection of fluid/air
When is pleurodesis indicated?
Second ipsilateral pneumothorax
First contralateral pneumothorax
Bilateral spontaneous pneumothorax
First pneumothorax in high risk professions
What is mesothelioma?
Rare, aggressive incurable cancer attacking the mesothelium
What is mesothelium?
Epithelium lining the pleura, peritoneum and pericardium
What causes mesothelioma?
Asbestos
What are asbestos?
Cause inflammation of pleura, provoking uncontrolled cell growth
Mesothelial cancerous plaques start to cover pleura
What are the signs and symptoms of mesothelioma?
Breathlessness
Chest pain
Weight loss
Clubbing
Signs of pleural effusion
What does CXR of mesothelioma show?
Pleural effusion
Pleural based mass
What does CT of mesothelioma show?
Thickened pleura
Pleural nodules/masses/plaques
What does CT of mesothelioma show?
Thickened pleura
Pleural nodules/masses/plaques
What is the management of mesothelioma?
Palliative
Treat effusion
Chemotherapy
