Pleural Disease Flashcards
Normal amount of fluid in pleural space?
less than 10 cc
-only parietal pleural is innervated
Causes of excess pleural fluid formation
- Leaky membranes (inflammation)
- Increased capillary hydrostatic pressure (CHF)
- decreased pleural pressure (atelectasis)
- Decreased capillary oncotic pressure (hypoalbuminemia)
Possible symptoms of Pleural effusion
- None
- Pain
- Dyspnea
- Respiratory Failure
Physical exam signs of pleural effusions
- dullness to percussion
- decreased breath sounds and tactile remits
- egophony
Evaluation of Effusions
- H & P
- Thoracentesis (Diagnostic is 50cc)
Criteria for exudates
- TP (pleura) / TP (serum) > 0.5
- LDH (pleura) / LDH (serum) > 0.6
- LDH (pleura) > 200 (or 2/3 upper normal)
- Cholesterol (pleura) > 45
Diseases causing Transudative Effusions
- CHF
- Cirrhosis
- Nephrotic syndrome
- Atelectasis
- Hypothyroidism
- Pulmonary Embolism (15%)
- Peritoneal Dialysis
Markers in Pleural effusions
-pH
low pH may be seen with infection (empyema), malignancy, and esophageal rupture
Markers in Pleural effusions
-Glucose
low glucose in rheumatoid arthritis, TB, cancer, empyema
Markers in Pleural effusions
-Total WBC
Not important unless frank pus
- many PMN’s suggest acute infection
- many lymphocytes suggest TB or or fungus
- more than 5% mesothelial cells speaks against TB
Markers in Pleural effusions
-Total RBC
Hematocrit in pleura > half of peripheral circulation is a hemothorax
Markers in Pleural effusions
-Amylase
-pancreatitis and/or esophageal rupture
Patterns with TB
- exudative
- lymphocytic
- less than 5% mesothelial cells
- (+) for ADA
- PPD negative early
Patterns with malignant effusions
- exudative
- lymphocytic
- RBCs
- maybe low pH
- low glucose
Patterns with PE
- 85 % are exudative
- unilateral
- might have blood
Patterns with Esophageal rupture
- Left sided
- low pH
- high amylase
Patterns with Endometriosis
- Bloody
- Prophylactic treatment with hemoptysis
Patterns with Hepatic effusions
-underlying cirrhosis
-transudates
-more right sided
rapid re-accumulation
Patterns with Milky effusions
- Chylothorax (TG > 110)
- malignancy, trauma, mediastinal disease (ruptured thoracic duct)
- Pseudochylothorax (TG >100 and Chol > 200)
- Empyema
What classifies a complicated exudate?
- very low pH and/ or glucose
- very high LDH
- it’s at risk to become an empyema
What is a pleurodesis?
chemical or mechanical irritation of the visceral or parietal pleura to create adhesion and obliteration of the pleural space
- prevents re-accumulation of fluid
- chemically or mechanically
How does a tension pneumothorax develop?
ball valve mechanism that leads to supra atmospheric pleural pressure
-causes decreased venous return and hypotension
Symptoms for pneumothorax
- Often asymptomatic
- chest pain
- dyspnea
- cough
- shock (tension only)
Physical exam for pneumothorax
- unilateral hyperinflation
- decreased breath sounds and tactile remits
- Hyper-resonance
