Pleural Disease Flashcards
What are the causes of pleural effusion?
Transudative causes include heart failure, cirrhosis, nephrotic syndrome, and hypoalbuminemia. Exudative causes include infections (pneumonia, tuberculosis), malignancies (lung cancer, mesothelioma), pulmonary embolism, rheumatologic conditions, post-cardiac surgery, pancreatitis, and trauma.
What are the clinical features of pleural effusion?
Symptoms include dyspnea, pleuritic chest pain, cough, fatigue, and orthopnea. Signs include decreased breath sounds, dullness to percussion, decreased tactile fremitus, reduced expansion on the affected side, and tracheal deviation.
What are the problems in differential diagnosis of pleural effusion?
Distinguishing transudative vs exudative effusions using Light’s criteria. Malignant effusions can mimic infections, requiring further testing. Differentiating from other pleural conditions may need imaging studies or biopsy.
What is the pathology of malignant mesothelioma?
Asbestos exposure is the primary risk factor. It develops from the pleural lining and can affect the peritoneum or pericardium. Histologically, it shows fibrous tissue proliferation with epithelioid and sarcomatoid patterns. Clinical features include chest pain, dyspnea, and pleural effusion, with a poor prognosis.
How is the approach to investigating a pleural effusion conducted?
Start with a thorough history and physical exam. Use imaging (chest X-ray, ultrasound, CT scan) to confirm and evaluate the effusion. Perform thoracentesis for fluid analysis, including cell count, protein levels, cytology, and cultures. Additional tests may be needed for suspected malignancy.
What is the management of common causes of pleural effusion?
For heart failure, use diuretics and oxygen therapy. For pneumonia, administer antibiotics and consider drainage. For malignancy, options include chemotherapy, radiotherapy, and thoracentesis. For tuberculosis, use antituberculosis therapy and drainage if necessary.
What is the management of more complex pleural conditions?
For pleural plaques, observation is recommended. For empyema, use antibiotics and drainage. For malignant pleural mesothelioma, employ multimodal treatment and palliative care for symptom management.
