Pleural disease

Question 1

What is a transudate effusion?

Answer 1

• low protein content
• caused by systemic problem
• unilateral or bilateral

Question 2

What is an exudate effusion?

Answer 2

• high protein content
• caused by pleural disease
• unilateral

Question 3

What is a parapneumonic effusion?

Answer 3

• steril exudate effusion

- in patients with pneumonia

Question 4

What is a complicated parapneumonic effusion?

Answer 4

• have become infected
• culture-positive
• pH lower than 7.2
• located or contain visibly turbid pleural fluid

Question 5

What is an empyema?

Answer 5

• caused by pleural infection
• accumulation of pud with turbid or culture-positive fluid
• acquired by a complication of parapneumonic effusion or without pneumonia

Question 6

What are loculated pleural effusions?

Answer 6

trapped fibrous adhesions between the visceral and parietal pleura

Question 7

What is a hydropneumothorax?

Answer 7

both air and water in the pleural space

Question 8

What is a haemothorax?

Answer 8

blood in the pleural space due to trauma

Question 9

What is a chylothorax?

Answer 9

accumulation of chyle in the pleural space by lymphatic system dustrubance as a result of lymphoma, cancer or trauma

Question 10

What is the diagnostic approach for pleural disease?

Answer 10

• CXR
• routine bloods
• aspiration of fluid to measure protein, LDH, glucose and pH with ultrasound guidance to decide whether it is transudate or exudate

Question 11

If an effusion is found to be exudate, what further test should be done?

Answer 11

• CT of thorax to assess pleural thickness and nodularity

- identify primary or secondary lung cancer

Question 12

What is the treatment of pleural disease?

Answer 12

• treat underlying cause
• pleural drainage
• pleurectomy to remove pleural space

Question 13

What is mesothelioma?

Answer 13

• cancer form mesothelial cells in the pleura

- tumours start as malignant plaques that can invade chest wall and mediastinum

Question 14

What will be seen on a CXR in pleural malignancy?

Answer 14

• decreased chest cavity size
• pleural thickening and effusion
• high protein pleural effusion

Question 15

What are the four stages of pleural malignancy?

Answer 15

1- no lymphadenopathy, remains within the parietal pleura
2- resection margins are positive and local lymphadenopathy
3- to chest wall and mediastinum, through diaphragm and may involve extra pleural lymph nodes
4- widespread metastatic disease

Question 16

Are surgery, radiotherapy or chemotherapy an option for pleural malignancy?

Answer 16

• surgery is difficult due to large surface-area
• radiotherapy is palliative
• chemotherapy is poor

Question 17

What is the prognosis for pleural malignancy?

Answer 17

11 months

Question 18

What is the pleura?

Answer 18

the mesothelial surface lining of the lungs and mediastinum

Question 19

What are the two type of pleural effusion?

Answer 19

• transudate (low protein so cardiac failure or hypoproteinaemia)
• exudate (high protein so pneumonia, TB, connective tissue disease or malignancy)

Question 20

What is a purulent effusion?

Answer 20

empyema

Question 21

What is a primary pleural neoplasia?

Answer 21

rare is benign or malignant mesothelioma

Question 22

What are secondary pleural neoplasia?

Answer 22

common so adenocarcinoma, GIT or ovary

Question 23

What is the pathology of mesothelioma?

Answer 23

mixed epithelial/ mesenchymal differentiation

Question 24

What is mesothelioma related to?

Answer 24

asbestos exposure