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Respiration > Pleural disease > Flashcards

Pleural disease Flashcards

1
Q

What is pleural effusion?

A

A collection of fluid in the pleural space

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2
Q

What is the mechanism by which pleural effusion comes about?

A

Imbalance between productions (mostly by parietal pleura) and absorption (by pleural lymphatics in the parietal pleura)

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3
Q

What are the two types of effusion?

A

Transudate
Exudate

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4
Q

What is transudate effusion?

A

Non inflammatory
Low protein content

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5
Q

What is exudate effusion?

A

Inflammatory fluid
High protein content

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6
Q

What are the common causes of transudate effusion?

A

Left ventricular failure
Liver cirrhosis

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7
Q

What are the common causes of exudate effusions?

A
  • Malignancy (pulmonary and non-pulmonary)
  • Parapneumonic effusions, empyema
  • Tuberculosis
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8
Q

What are the less common causes of exudate effusion?

A

Pulmonary embolism
Connective tissue disease
Benign asbestos pleural effusion
Pancreatitis
Post-myocardial infection
Post-coronary artery bypass graft
Haemothorax, chylothorax

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9
Q

What are the rare causes of exudate effusion?

A

Yellow nail syndrome
Drugs
Fungal infections

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10
Q

What are the less common causes of transudate effusion?

A
  • Hypoalbuminemia
  • Nephrotic syndrome
  • Mitral stenosis
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11
Q

What are the rare causes of transudate effusion?

A
  • Constrictive pericarditis
  • Urinothorax
  • Meigs’ syndrome
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12
Q

What do you use to distinguish between transudate and exudate?

A

Lights criteria

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13
Q

What are the points of lights criteria?

A

Protein: pleural fluid/serum fluid > 0.5
LDH: pleural fluid/serum fluid > 0.6
Pleural fluid: LDH > 2/3 upper limit of normal serum LDH

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14
Q

What is a pneumothorax?

A

Air in the pleural cavity

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15
Q

What causes primary/secondary spontaneous pneumothorax?

A

Occur due to blebs (weak areas on lung surface) which rupture spontaneously and leak air into pleural cavity.

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16
Q

What makes a pneumothorax secondary?

A

Pre-existing lung conditions
e.g. interstitial lung disease, COPD, CF, asthma, pleural endometriosis, genetic disorders

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17
Q

How does a pneumothorax present?

A

Chest pain
Breathlessness
Tachypnoeic
Hypoxic
Reduced chest wall movement
Reduced breath sounds
Hyper resonant during percussion
**examination may be normal

18
Q

Who is at risk?

A

Tall thin young men
Underlying lung disease
History of biopsy/line insertion/mechanical ventilation

19
Q

What investigations are done to get diagnosis?

A

CXR
US
CT thorax

20
Q

What are the management options for a pneumothorax?

A

Observe
- If patient well and pneumothorax is small
Aspiration
- If pneumothorax is over 2cm in size
- If patient is well
Chest drain insertion
- Channel allows air to be drained
- Left in place until pneumothorax resolves
- For large pneumothoraxes
Surgery
- Recurrent events
- Unresolving

21
Q

What are the causes of pneumothorax?

A

Spontaneous
Traumatic
Iatrogenic
Tension

22
Q

How do traumatic pneumothoraxes occur?

A

As a result of injury to the chest wall of the lung
e.g. fractured ribs puncturing the lung, knife injury and penetrating would to chest wall.

23
Q

How do iatrogenic pneumothoraxes occur?

A

Result of biopsy of lung
Patient on ventilator
Inserting central venous line
Pacemaker

24
Q

How do tension pneumothoraxes occur?

A
  • Can be life threatening emergency
  • Air in pneumothorax builds up to the point it causes pressure and pushes central structures and squashes opposite lung
  • Applies pressure on heart so more difficult to fill so BP drops
  • May require emergency aspiration
  • Less common and can happen with ventilation or trauma patients
25
Q

What is mesothelioma malignancy?

A

A cancer of the pleura (primary malignancy)

26
Q

What are the causes of mesothelioma malignancy?

A

Spontaneous
Exposure to asbestos fibres

27
Q

What occupations are most at risk of malignant mesothelioma?

A

Plumbers, electricians, shipbuilding, power plants, boilers, engines

28
Q

What is the pathology of mesothelioma?

A

Inhaled asbestos fibres reach the pleura and cause inflammation provoking tumour formation.
Cycle of inflammation and repair = tumour

29
Q

How long is the latency period for mesothelioma?

A

20-40 years

30
Q

What are the clinical signs of mesothelioma?

A

Breathlessness
Chest pain
Weight loss
Clubbed fingers
Signs of pleural effusion

31
Q

How do you diagnose mesothelioma?

A

CXR
CT thorax
Biopsy

32
Q

What signs are you looking for when diagnosing malignant mesothelioma?

A

Thickened pleura
Pleural nodules or masses
Pleural plaques
An effusion
Soft tissue infiltration

33
Q

What are the management options for malignant mesothelioma?

A
  • Limited treatment options
  • Palliative, survival is poor
  • Treating the effusion
  • Chemotherapy - only for select few, small survival benefit
  • Recruitment to trails via MDTs
  • Palliative surgery in select patients
34
Q

What are the most common sites of metastasis (secondary tumour) of malignant mesothelioma?

A

Interparental
Breast
Ovarian
Renal
GI tract
Thyroid

35
Q

What investigations are done for pleural effusion?

A

Ultra sound
CXR
CT thorax

36
Q

Describe how ultra sound can be used in pleural effusion?

A

Mark site for aspiration
Assess pleura
Can be done at bedside
More sensitive than CXR

37
Q

Describe how CXR can be used in pleural effusion?

A

Need about 100-200ml of fluid for effusion to become visible on CXR
Is accessible
Easy to interpretate

38
Q

Describe how CT thorax can be used in pleural effusion?

A

For complex effusions
Visualising the pleura, vascular and mediastinal structures in greater detail
Can identify pockets of fluid
Identify nodules/lumps/bumps/thickening of the pleural surface

39
Q

Explain the process of pleural fluid analysis and what is analysed?

A

Aspirate fluid
- Inspect fluid -> Pus? Blood?
- pH using an ABG: if pH < 7.2 in presence of pneumonia then chest drain is needed. As its likely that this will form pus and thus be more difficult to control.

40
Q

What is done in the management of pleural effusion?
a) if pH < 7.2
b) if effusion transudate
c) if effusion exudate

A

a) If with pneumonia, pus or blood = chest drain.
b) Treat underlying cause.
c) Unless cause if identified will need further investigations e.g. imaging or/and pleural biopsy.

41
Q

What are pleural plaques?

A

Areas where the pleura becomes thickened

42
Q

What is empyema?

A

Pockets of pus that collect inside the pleural cavity

Respiration (27 decks)

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