Pleural Disease Flashcards
What is the pleural cavity?
Potential space created by pleural surfaces
Serous membrane folds back on itself
Contains pleural fluid
What is the outer pleura attached to the chest wall called?
Parietal pleura
What is the inner pleura covering the lungs called?
Visceral pleura
What is a pneumothorax?
Air in the pleural cavity
What is a pleural effusion?
Fluid in the pleural cavity
What is empyema?
Infected fluid in the pleural cavity
What are pleural plaques?
Discrete fibrous areas
What causes pleural thickening?
Scarring and calcification
What are the types of pneumothorax?
Spontaneous (primary vs secondary)
Traumatic
Tension
Iatrogenic
What is the difference between the two types of spontaneous pneumothorax?
Primary there is no lung disease
Secondary there is lung disease
What are some risk factors for pneumothorax?
Pre existing lung disease Height Smoking/cannabis Diving Trauma/chest procedure Other conditions e.g. marfans
What is the management for primary pneumothorax?
If symptomatic and rim of air >2cm on CXR give O2 and aspirate
If unsuccessful, respirate and consider intercostal drain
What is the management for secondary pneumothorax?
Same as for primary but with a lower threshold for intercostal drain
What should be done if there is a bronchopleural fistula?
If persistent air leak for >5days then refer to thoracic surgeons
What is the discharge advice for pneumothorax patients?
No flying or diving until resolved
How should a suspected pleural effusion be approached?
Good history and examination
CXR, ECG, Bloods: FBC, U&E, LFT, CRP, bone profile, LDH, clotting, ECHO if suspect heart failure, staging Ct with contrast if suspect an exudative cause
How should pleural effusion be diagnosed?
Ultrasound guided pleural aspiration
(biochem- protein, pH, LDH, cytology, microbiology including AAFB)
Could do thoracoscopy or CT pleural biopsy
Why should you never insert a chest drain in pleural effusion unless the diagnosis/cause is well established?
May hinder the opportunity to obtain pleural biopsies
When would the only indication for urgent chest drain insertion for a new effusion be?
An underlying empyema
(pH of pleural fluid <7.2 or visible pus on aspirate
What would the pleural protein level be for transudate effusions?
pleural protein <30g/L
What are some common causes of transudate effusions?
Heart failure, cirrhosis, hypoalbuminaemia (nephrotic syndrome or peritoneal dialysis)
What are some less common causes of transudate effusions?
Hypothyroidism, mitral stenosis, pulmonary embolism
What are some rare causes of transudate effusions?
Constrictive pericarditis, superior vena cava obstructio, meigs syndrome
What would the pleural protein level be in an exudate effusion?
> 30g/L
What are some common causes of exudate effusions?
Malignancy
Infections - parapneumoic, TB, HIV (kaposis)
What are some less common causes of exudate effuisions?
Inflammatory (RA, pancreatitis etc)
Lymphatic disorders
Connective tissue disease
What are some rare causes of exudate effusions?
Yellow nail syndrome, fungal infections, drugs
When should Lights criteria be used?
If pleural fluid protein level is between 25-30g/L
What are Lights criteria
Exudate if one or more of
Pleural fluid/serum protein >0.5
Pleural fluid/serum LDH >0.6
Pleural fluid LDH >2/3 upper limit of normal
