Pleural Disease Flashcards
What is the turnover of pleural fluid?
30-75% per hour
What is a pleural effusion?
The abnormal collection of fluid in the pleural space
How can pleural effusion be asymptomatic?
If it is small and accumulates slowly
What are the symptoms of a pleural effusion?
Increasingly breathless Pleuritic chest pain Dull ache Dry cough Weight loss Malaise Fevers Night Sweats
When is a dry cough most common?
During rapid accumulation
What are the two causes of pleuritic chest pain and what are there outcomes?
Inflammatory - ear;y, may improve as fluid accumulates
Malignancy - progressively worsening
What are the signs of pleural effusion?
Reduced chest expansion Stony dullness on percussion Low breath sounds Low vocal resonance Clubbing Tar staining of fingers Cervical lymphadenopathy Increased jugular venous pressure Peripheral oedema Trachea moved away from large effusion
What are the two types of fluid that makes up a pleural effusion?
Transudates
Exudates
What is usually the cause of transudates pleural effusion?
An imbalance of hydrostatic forces influencing the formation and absorption of pleural fluid
What is usually the cause of an exudate pleural effusion?
Increased permeability of pleural surface and/or local capillaries
What investigations can be done?
Chest radiograph
Contrast enhanced CT of the thorax
Pleural aspiration and biopsy
Thoracoscopy
When should an investigation be carried out?
If there are unusual features
Failure to response to appropriate treatment
How many biopsies should be done?
At least 4, 3 in formaldehyde and 1 in saline if TB suspected
What are the possible treatments of pleural effusion?
Chemotherapy Antituberculous chemotherapy Corticosteroids Pleurodhesis Surgical pleurodhesis
What is a pneumothorax?
Presence of air within the pleural cavity
What are the 4 types of pneumothorax?
Primary spontaneous
Secondary spontaneous
Non-iatrogenic
Iatrogenic
What are the symptoms of a pneumothorax?
Acute breathlessness
Worsening breathlessness
Pleuritic chest pain
Extreme dyspnoea
What are the signs of a non tension pneumothorax?
Trachea diverted to affected side
Less expansion
Hyper resonant
Absent or low breath sounds
What are the signs of a tension pneumothorax?
Trachea deviated away from affected side
Haemodynamic compromise
Increased jugular venous pressure
When are there no signs or symptoms of a pneumothorax?
when it is small and there is still good ventilation
What is the management of a tension pneumothorax?
An intercostal chest drain
Where in an intercostal chest drain placed?
2nd intercostal space at the mid-clavicular line
What is the management of a small primary pneumothorax where the patient is not breathless?
Observe overnight
Repeat CXR
If there is no change the whole has sealed so discharge and advice against vigorous activity and review in 2 weeks
What is the management of a breathless primary pneumothorax?
Aspirate pneumothorax
If unsuccessful chest drain
