Pleural Disease Flashcards

1
Q

Diagnostic criteria for chylothorax

A
  • chylomicrons in pleural fluid on lipoprotein analysis

- surrogate: TG >110

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2
Q

Chylothorax cause: location of lesion

A

trauma, mediastinal malignancy, LAM, sarcoidosis, TB

Disruption of thoracic duct- crosses midline at T4-T5 (above this left-sided, below this right-sided)

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3
Q

Pleural marker for pleuro-dural fistula

A

beta-2-transferrin

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4
Q

Infection that can lead to complicated parapneumonic with high pH?

A

Proteus

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5
Q

Pseudoexudate: Cutoff

A

CHF, on diuresis, exudate by lytes:

  1. serum to fluid albumin gradient >1.2
  2. serum to fluid protein gradient >3.1
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6
Q

In patient with nephrotic syndrome and exudative effusion must consider:

A

PE

  • acquired protein S defic
  • occurs in 20% of nephrotic syndrome patients
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7
Q

Glucose range for PD related effusion

A

200-2000 (midway serum and diasylate)

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8
Q

Diagnose urinothorax

A
  • low pH transudate

- pleural fluid/serum Cr ration >1

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9
Q

Indications for chest tube in parapneumonic effusion:

A
  1. Frank pus
  2. Positive gram stain or culture
  3. pH <7.2 (or Glu <60)
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10
Q

Sensitivity of cytology in malignant effusion

A
  1. 60%
  2. 72%
  3. 77%
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11
Q

Diagnosis of PCIS:

A

Usually 3 weeks postop, presents with Dressler’s (fever, pericarditis, pleuritis)

  • High titer antimyocardial Ab
  • Tx Indomethacin, maybe steroids
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12
Q

Difference between chylothorax and pseudochylothorax

A

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

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13
Q

Elevated amylase effusion- etiologies

A

Acute pancreatitis
Chronic pancreatitis
Esophageal rupture
Malignancy

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14
Q

Recurrence rates:

  • primary spontaneous PTX
  • secondary spontanesous PTX
A
  • 30%

- 40%

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15
Q

When to offer prevention to patient with PTX:

A

PSP- after second time

SSP- after first time

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