Pleural disease Flashcards
Which conditions can cause a “pleural rub”?
Anything that causes inflammation of the pleura - PE or pneumonia
Is there a pleural rub audible in pleural effusion?
No, the fluid in the pleural cavity keeps the two surfaces from touching so there is no rub to be heard.
What is the pulmonary ligament?
Attachment of the root of the lung to the diaphragm
Consists of the two layers of pleura combining around the root of the lung
What type of nerves supply the parietal pleura and what are their names?
Somatic sensory - senses pain
Supplied by the intercostal and phrenic nerves
What type of nerves supply the visceral pleura and which nerve does this?
Autonomic - senses stretch
Vagus nerve
How is effusion diagnosed?
History
CXR
Aspiration - transudate or exudate?
What does an effusion with a bloody appearance indicate?
Trauma
Malignancy
Infection
Infarction
What does an effusion with a straw-coloured appearance indicate?
Cardiac failure
Hypoalbuminaemia
What does an effusion with a turbid/milky appearance indicate?
Chylothorax
Empyema
What is the definition of a transudate effusion?
Effusion with a protein level <30g/L
What is the definition of an exudate effusion?
Effusion with a protein level >30g/L
What does a transudate effusion indicate?
"Organ failure" Cardiac failure Liver cirrhosis Nephrotic syndrome Hypothyroidism
What does an exudate effusion indicate?
Malignancy Infection PE Rheumatoid TB Benign asbestos related effusion Pancreatitis
Which workers are at risk of developing asbestosis?
Miners Construction workers Boiler workers Piping workers Mechanics
What is the characteristic pathology of asbestosis?
Benign pleural plaques
What are benign pleural plaques at risk of developing into?
Mesothelioma - incurable cancer of the pleura
How is asbestosis diagnosed?
Asbestos bodies can be detected in sputum and biopsy
What other cancer are asbestosis patients at risk of developing?
Bronchial carcinoma
What interstitial lung disease does asbestos exposure also cause?
Pulmonary fibrosis producing a restrictive pattern
What changes occur in the pleura of patients with asbestosis?
Exudative pleural effusion
Diffuse pleural thickening
Benign pleural plaques
How is pleurodesis performed?
Inflammation is induced between the two pleural surfaces, leading to all symptoms of pleurisy in the short term, but ultimately the inflammation allows the two surfaces to stick together, leaving no space for fluid to accumulate - this can be done by injecting talc
What should the pH of aspirated effusion be?
pH 7.6
<7.2 needs to be drained
How should effusion be treated?
Treat underlying cause
Thoracentesis (chest drainage)
Why should large volumes of fluid not be drained all at once?
Risk of re-expansion pulmonary oedema - this can be life threatening
What volume of fluid should be drained at what rate?
1L should be drained before drain is clamped for an hour to allow gradual re-expansion
