Pleural Disease Flashcards
what is a pleural effusion
Abnormal collection of fluid in the pleural space
what are symptoms of pleural effusion
increasing breathlessness pleuritic chest pain dull ache dry cough weight loss malaise fevers night sweats
what do you need to enquire about when taking symptoms from a patient with pleural effusion
have they had: peripheral oedema liver disease orthopnoea PND
what are clinical signs of pleural effusion
affected side will have: decrease in expansion stony dullness to percuss decreases breath sounds decrease vocal resonance
what are common transudate causes of plueral effusion
LV failure
liver cirrhosis
hypoalbuminaemia
peritoneal dialysis
what are less common transudate causes of pleural effusion
hypothyroidism
nephrotic syndrome
mitral stenosis
pulmonary embolism
what are common exudate causes of pleural effusion
malignacy
parapneumonic
what are less common exudate causes of pleural effusion
PE
post-MI
rheumatoid arthritis
what investigations would you do for pleural effusion
CXR
contrast enhanced CT of thorax
pleural aspiration and biopsy
what can be complications of pleural aspiration and biopsy
Pneumothorax Empyema Pulmonary oedema Vagal reflex Air embolism
after pleural aspiration the fluid can be analysed on the ward by looking at it and smelling. what might you see/smell in the fluid aspirated
foul smelling-anaerobic empyema pus-empyema food particles-oesophageal rupture milky-chylothorax blood stained- malignacy? blood-haemothrax,trauma
after a pleural aspiration the fluid can be analysed to tell wether it is transudate or exudate, how would this be done
exudate if it had 30g/L of protein or more
where in relation to the rib would you take a biopsy
immediately above a rib, do not biopsy with cutting edge upwards
how many biopsies should be taken
at least 4
what do you have to do with 3 of the biopsies
at least 3 put into formaldehyde for histology
what do you have to do with 1 of the biopsies and why
at least 1 in saline to send to microbiology, this is done if TB is suspected
if you have investigated a pleural effusion with the normal set of tests but have no diagnosis what other investigation could be carried out
thoracoscopy as it gives direct inspection of the pleura
what is the management of pleural effusion
Treatment directed at the cause: chemotherapy antituberculous chemotherapy corticosteroids repeated drainage Pleurodhesis
what is a pneumothorax
Presence of air within the pleural cavity
what are the types of pneumothorax
primary spontaneous
secondary spontaneous
non-iatrogenic
iatrogenic
who gets primary spontaneous pneumothroax and why is it believed to happen
more men than wome
young peak incidence 20-30y
happens to tall thin people
believed to be due to weight of the lung inducing development of apical blebs
when can spontaneous pneumothorax happen
in almost any lung disease: asthma COPD pneumonia TB cystic fibrosis sarcoidosis
what can cause traumatic non-intragenic pneumothorax
penetrating chest injury-stab
blunt injury-rib fracture
what can cause traumatic intragenic pneumothorax
pleural aspiration
acupuncture
pleural aspiration/biopsy
