Pleural Disease Flashcards
Diagnostic criteria for chylothorax
- chylomicrons in pleural fluid on lipoprotein analysis
- surrogate: TG >110
Chylothorax cause: location of lesion
trauma, mediastinal malignancy, LAM, sarcoidosis, TB
Disruption of thoracic duct- crosses midline at T4-T5 (above this left-sided, below this right-sided)
Pleural marker for pleuro-dural fistula
beta-2-transferrin
Infection that can lead to complicated parapneumonic with high pH?
Proteus
Pseudoexudate: Cutoff
CHF, on diuresis, exudate by lytes:
- serum to fluid albumin gradient >1.2
- serum to fluid protein gradient >3.1
In patient with nephrotic syndrome and exudative effusion must consider:
PE
- acquired protein S defic
- occurs in 20% of nephrotic syndrome patients
Glucose range for PD related effusion
200-2000 (midway serum and diasylate)
Diagnose urinothorax
- low pH transudate
- pleural fluid/serum Cr ration >1
Indications for chest tube in parapneumonic effusion:
- Frank pus
- Positive gram stain or culture
- pH <7.2 (or Glu <60)
Sensitivity of cytology in malignant effusion
- 60%
- 72%
- 77%
Diagnosis of PCIS:
Usually 3 weeks postop, presents with Dressler’s (fever, pericarditis, pleuritis)
- High titer antimyocardial Ab
- Tx Indomethacin, maybe steroids
Difference between chylothorax and pseudochylothorax
chylothorax- TG >110 or presence of chylomicrons on electrophoresis
Etiology: tumor (NHL), trauma/iatrogenic, LAM, KS, yellow nail, histo, MM, Waldenstrom, IgG 4, constrictive pericarditis
pseudochylothorax- Chol >220, TG can be >110, but no CMs
Etiology pseudochylothorax- shaggy pleura from RA, TB, empyema
Elevated amylase effusion- etiologies
Acute pancreatitis
Chronic pancreatitis
Esophageal rupture
Malignancy
Recurrence rates:
- primary spontaneous PTX
- secondary spontanesous PTX
- 30%
- 40%
When to offer prevention to patient with PTX:
PSP- after second time
SSP- after first time