Pleural disease Flashcards
Black pleural fluid
Aspergillus niger
Milky pleural fluid
Chylothorax/pseudochylothorax
Yellow-green pleural fluid
Rheumatoid pleuritis
Anchovy paste pleural fluid
amebic liver abscess
Bloody pleural fluid
Hemothorax
Cancer
PE
Trauma
iatrogenic
Ammonia odor in pleural fluid
Urinothorax
Brown pleural fluid
Hemothorax (old)
Amebic liver abscess
Green pleural fluid
Cholothorax (biliary fistula)
Water like pleural fluid
Duro-pleural fistula
LDH >1000 pleural fluid
Empyema
complicated parapneumonic effusion
Cholesterol effusion
rheumatoid pleurisy
primary pleural lymphoma
paragonimiasis
Low glucose in pleural fluid
Empyema
Chronic rheumatic pleurisy
esophageal rupture
malignancy
paragonimiasis
acute lupus pleuritis
TB
High amylase in pleural fluid
Acute pancreatitis
esophageal rupture
malignancy
Total protein >7-8 in pleural fluid
Multiple myeloma
Rheumatoid pleurisy
Waldenstrom’s macroglobulinemia
Total protein >4 in pleural fluid
Cholesterol effusion
TB
Total protein <1in pleural fluid
Duropleural fistula
Urinothorax
peritoneal dialysis
Drugs that can lead to high eos in pleural fluid
Dantrolene, bromocriptine, nitrofurantoin, valproic acid
pleural fluid with lymphocytosis predominance
Malignancy
Chronic rheumatoid pleurisy
chylothorax
Post CABG
Sarcoid
TB
uremic effusion
yellow nail syndrome
if PH <7.3
-malignancy
- Chronic rhem
- TB
pleural fluid with eos (>10%) predominance
PTX (w/in hrs)
Hemothorax (after 10-14d)
pulm infarct
parasitic or fungal dz (histo, crypto)
Drug induced
lymphoma, carcinoma
pleural fluid with neutrophil predominance
Acute pleural injury
infection
inflammation
pleural fluid with >10% eos and pH <7.3
Paragonimiasis
pleural fluid with predominant neutrophils and pH <7.3
Empyema
acute esophageal rupture
acute lupus pleurisy
cholesterol effusion
Causes of Low ph (<7.3) in pleural fluid
Empyema
esophageal rupture
chronic rheum pleursy
Cholesterol effu
Malignacy
TB
Acute lupus pleuritis
Paragonamiasis
3 test rule for exudate
PF protein >/= 3
PF Cholesterol >45
PF LDH > 45% upper limit nl S LDH
Serum measures to help make sure it is exudate vs transudate
Transudate if:
- Albumin gradient (S-PF) >1.2
- Total protein gradient >3.1
- PF/S albumin <0.6
- S or PF BNP >1500
Helps to confirm if HF or hepatic hydrothorax
Dressler’s syndrome pleural fluid characteristics
Post-cardiac injury syndrome
Small effusion, unilateral or bilateral
Bloody or serosang
PMN or monos
High BNP
Treat with NSAIDs or steroids
Colchicine for ppx
Characteristics of pleural fluid in PE
Exudate
Can be uni or bilateral
Neutrophil, bloody
Characteristics of pleural fluid in pancreatitis
Exudate
elevated amylase
DDX esophageal rupture and malign
Check isoenzymes
Characteristics of pleural fluid in RA
Exudate
painless
low pH and glucose
Characteristics of pleural fluid in Lupus
Exudate
Higher glucose compared to RA
Painful
LE cells are highly specific
Causes of pseudochylous pleural fluid
TB
Rheum
Helminth infxn
Yellow nail syndrome pulm characteristics
Exudative pleural effusion
Bronchiectasis
Sinusitis
Conditions that can present with PTX initially
Catamenial (endometrial implants)
Cystic lung dz
infections (HIV, PJP, TB, necrotizing)
When to do definitive procedure for primary spontaneous PTX?
- Recurrent PTX
- Large size or high severity needing CT
- High risk profession
- High burden of cysts
- Pt wants intervention
- Persistent air leak (5-7d)
- Need for lung biopsy
Mesothelial markers
Calretinin
CK 5/6
D2-40
WT-1
Adenocarcinoma markers
CEA
B27.3
Bg8
BerEP4
MOC-31
Squamous cell carcinoma markers
P40
P63
CK5/6
Lung cancer marker in Pleural fluid
TTF-1
Napsin A
GI cancer marker in Pleural fluid
CDX-2
CK20
Kidney cancer marker in Pleural fluid
PAX-2, PAX-8, RCC, CAIX
GYN cancer marker in Pleural fluid
PAX-8, WT1
Breast cancer marker in Pleural fluid
ER/PR
GATA 3
Mammaglobin
GCDFP-15
Sensitivity of pleural fluid cytology?
Depends on tumor type
40-87%
good for lung adeno, breast and ovarian
BAD - mesothelioma and squamous cell of lung
Most common chemos to cause pleural eff
Dasatinib
Gemcitabine
Prognostic scores in malignant pleural effusion?
LENT- PF LDH, ECOG, neutrophil to lymph ratio and tumor type
PROMISE - estimates 3 mo mortality
Neither have been shown to assess improved outcomes
