Pleural disease Flashcards by Jacqueline Dinh

Black pleural fluid

Aspergillus niger

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Milky pleural fluid

Chylothorax/pseudochylothorax

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Yellow-green pleural fluid

Rheumatoid pleuritis

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Anchovy paste pleural fluid

amebic liver abscess

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Bloody pleural fluid

Hemothorax
Cancer
PE
Trauma
iatrogenic

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Ammonia odor in pleural fluid

Urinothorax

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Brown pleural fluid

Hemothorax (old)
Amebic liver abscess

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Green pleural fluid

Cholothorax (biliary fistula)

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Water like pleural fluid

Duro-pleural fistula

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LDH >1000 pleural fluid

Empyema
complicated parapneumonic effusion
Cholesterol effusion
rheumatoid pleurisy
primary pleural lymphoma
paragonimiasis

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Low glucose in pleural fluid

Empyema
Chronic rheumatic pleurisy
esophageal rupture
malignancy
paragonimiasis
acute lupus pleuritis
TB

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High amylase in pleural fluid

Acute pancreatitis
esophageal rupture
malignancy

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Total protein >7-8 in pleural fluid

Multiple myeloma
Rheumatoid pleurisy
Waldenstrom’s macroglobulinemia

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Total protein >4 in pleural fluid

Cholesterol effusion
TB

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Total protein <1in pleural fluid

Duropleural fistula
Urinothorax
peritoneal dialysis

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Drugs that can lead to high eos in pleural fluid

Dantrolene, bromocriptine, nitrofurantoin, valproic acid

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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

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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

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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