Pleural Disease Flashcards
Describe the structure of the pleura.
Glistening, smooth, thin membrane which covers the thoracic cavity and the lung
RECAP- name the pleura on the outside of the lung
Parietal
RECAP- name the pleura on the inside of the lung.
Visceral
What is found between the parietal and visceral pleura?
Plural fluid
What process produces pleural fluid?
Filtration
Name some of the cells found in pleural fluid.
Macrophages, lymphocytes, mesothelial cells
What type of pressure does the pleura have?
Subatmospheric pressure
What part of the lung has the most negative pressure?
Apex
RECAP- what is the collection of fluid in the pleural cavity called?
Pleural effusion
RECAP- what is a collection of air in the pleural cavity known as?
Pneumothorax
What is the term for pleural malignancy?
Mesothelioma
What is a combination of water and air in the parietal cavity known as?
Hydropneumothorax
Why does pleural effusion occur?
Imbalance between production and absorption
Name the two types of pleural effusion.
Transudate
Exudate
Is transudate non-inflammatory or inflammatory?
Non-inflammatory
Is exudate inflammatory or non-inflammatory?
Inflammatory
Which type of pleural effusion has a high protein content?
Exudate
What is the protein content of exudate?
3g/dl or more
Which criteria can determine if pleural effusion is exudate/
Light’s criteria
Name two very common causes of transudates.
Left ventricular failure
Liver cirrhosis
(she said we need to know three so one less common cause is Nephrotic syndrome)
Name some common causes of exudates.
Malignancy ( Pulmonary and non pulmonary)
Parapneumonic effusions, empyema
Tuberculosis
What tests can be used to diagnose pleural effusion?
Ultrasound
Chest x-ray
CT thorax
List the advantages of using an ultrasound.
More sensitive than CXR , mark site for aspiration, assess pleura, bedside
List the advantages of using a chest x-ray
Accessible , easy to interpret
List the advantages of using a CT of the thorax.
Allows better look at complex effusions , visualising the pleura , vascular and mediastinal structures
Discuss the process of pleural fluid analysis.
Collect a sample via aspiration
Inspect the fluid-> pus, blood etc.
Check pH on bedside ABG machine
What do you do if the pH of the sample is <7.2?
May need chest drain
What is a primary spontaneous pneumothorax?
Spontaneous rupture in normal lungs
What is a secondary spontaneous pneumothorax?
Rupture occurs in someone with a pre-existing condition
Which pre-existing lung diseases may lead to a secondary spontaneous pneumothorax?
Interstitial lung disease
COPD
Asthma
Cystic fibrosis
What is a traumatic pneomothorax?
Pneumothorax as a result to injury
What is an iatrogenic pneumothorax?
As a result to a procedure like lung biopsies.
What is a tension pnuemothorax?
Air builds up and pushes structures, like the trachea, and squashes the other lung and puts pressure on the heart.
Which type of pneumothorax can be very dangerous?
Tension pneumothorax
Who usually gets a primary spontaneous pneumothorax?
Tall, thin, young men.
uh oh good luck jmatt
What are the presenting symptoms of a spontaneous pneumothorax?
Chest pain or breathlessness
What would you commonly see during examination in someone with a pneumthorax?
Breathing fast : tachypneic
Hypoxic
Reduced chest wall movement and reduced or no breath sounds
Not uncommonly examination may be normal
When would you choose to observe a patient w a pneumothorax?
If they are well and the size of the pneumothorax is small
When would you choose to collect a sample (aspiration) from a patient with pneumothorax?
Pneumothorax over 2 cm in size , patient well
When would a patient be given surgery for pneumothorax?
Recurrent events, unresolving
What is a management option for those in hospital and requires anaesthetic?
Chest drain insertion
Where is it safe to do a pleural aspiration/ drain?
2nd intercostal space, midclavicular line
Are most pleural tumours benign or maligant?
Malignant
What is meant by secondary pleural malignancy?
Malignancy has developed as a result of cancer elsewhere in the body.
What is the most common primary malignant tumour?
Mesothelioma
Why may mesothelioma arise?
In some cases, by a mutation.
More commonly, due to the inhalation of asbestos dust and fibres.
How does asbestos cause the formation of tumours?
Inhaled fibres reach the pleura and cause inflammation hence causing a tumour to form
How long after inhaling asbestos can mesothelioma develop?
20-40 years
Name some symptoms that suggest a mesothelioma has developed.
Breathlessness
Weight loss
Chest pain
Clubbing, sign of pleural effusion
What could you do for the diagnosis of a mesothelioma?
Biopsy
CT Thorax
Thoracoscopy
Discuss management options for mesothelioma.
Incurable
Treating the effusion
Chemo
Palliative surgery for some
Recruitment to trials
What is the only imaging modality that allows a site for drainage of a pleural effusion to be marked?
Ultrasound
What are pleural plaques?
Benign areas of thickened tissue in the pleura
When may a person develop pleural plaques?
20-40 years after exposure to asbestos
What is the treatment for pleural plaques?
No treatment unless very large.
List some more general causes of transudates.
Heart failure
Nephrotic syndrome
Constrictive pericarditis
Cirrhosis
List some more general causes of exudates.
Lung malignancy
Pneumonia
Mesothelioma
Rheumatoid arthritis.
