Pleural Disease Flashcards
What is the pleura composed of?
Single layer of mesothelial cells
What are the forces acting across the pleura?
Where does the pleura extend to?
Pleura over the first rib
Pleura over the liver, spleen, kidney
What is pleural effusion defined as?
Abnormal collection of fluid in the pleural space
What are the symptoms of pleural effusion?
Asymptomatic – if small and accumulates slowly
Increasing breathless (days, weeks, months)
Pleuritic chest pain
(cause of pleural fluid) inflammatory: early, may improve as fluid accumulates
malignancy: progressively worsening
Dull ache
Dry cough – especially if rapid accumulation
Weight loss, malaise, fevers, night sweats
Need to enquire about peripheral oedema, liver disease, orthopnoea, PND
What are the signs of pleural effusion?
What are the causes for pleural effusion?
What are the two types of pleural effusion?
transudates and exudates
How do you distinguish between transudates and exudates?
Determined by the pleural fluid protein
What is the definition of a transudate?
Pleural fluid protein < 25g/l, for exams < 30g/l
What are the causes of a transudate?
What is the definition of an exudate?
Pleural fluid protein > 35g/l, for exams > 30g/l
What are the causes of exudate?
Do you need to investigate for transudates?
Not usually, clinical picture is usually characteristic
When should you investigate a transudate?
If there are unusual features
Failure to respond to appropriate treatment
How do you confim presence of effusion?
Chest radiograph
Pleural aspiration and biopsy
Contrast enhanced CT of thorax (
Usually differentiates between malignant and benign disease
nodular pleural thickening
mediastinal pleural thickening
parietal pleural thickening >1cm
circumferential pleural thickening
other malignant manifestations in lung/liver)
What are the possible complications for aspiration?
You use (
50ml syringe 21G needle (green), lignocaine anaesthesia
(guidelines recommend bedside US guidance)
Sterile universal containers
Blood culture bottles)
Pneumothorax
Empyema
Pulmonary oedema
Vagal reflex
Air embolism
Tumour cell seeding
Haemothorax
Define pleural aspiration
A pleural aspiration is a procedure where a small needle or tube is inserted into the space between the lung and chest wall to remove fluid that has accumulated around the lung.
What does foul smelling pleural fluid indicate?
Anaerobic empyema
What does pus in the pleural fluid indicate?
Empyema
What does food in the pleural fluid indicate?
Oesophageal rupture
What does milky pleural fluid indicate?
Cyclothorax - usually lymphoma
What is cyclothorax?
A chylothorax (or chyle leak) is a type of pleural effusion. It results from lymph formed in the digestive system called chyle accumulating in the pleural cavity due to either disruption or obstruction of the thoracic duct.
What is the biochemistry anaysis of the pleural fluid?
Measures levels of protein, Lactate dehydrogenase (LDH), amylase (increase could indicate pancreatitis), looking out for empyema, rheumatoid arthritis, SLE
(Systemic lupus erythematosus (SLE) is an autoimmune disease. In this disease, the body’s immune system mistakenly attacks healthy tissue. It can affect the skin, joints, kidneys, brain, and other organs.)
TB
Malignancy
What do Microbiology test the pleural fluid for?
Gram stain (determines the class of bacteria)
AAFB - Alcohol, acid fast bacilli?
Culture
Microscopy, culture and sensitivity
What is cytology?
The branch of biology concerned with the structure and function of plant and animal cells.