Pleural disease Flashcards
what is a pleural effusion
collection of fluid between two pleural layers of lung (in the pleural space)
what are you looking for when you inspect pleural fluid
cloudy
blood
pus
pus in pleural fluid can mean what?
empyema
Cloudy pleural fluid can mean what?
exudate - protein
infection
milky (chylothorax- rare)
Blood in pleural fluid can mean what?
malignancy
TB
trauma
infarct
which microbiology tests are always used to inspect pleural fluid?
gram stain
AAFB - Alcohol and acid fast bacilli (continuous automated bacterial culture - can take up to 8 weeks) - mainly checking for AFB for TB diagnosis
culture
when should you drain an effusion?
when it is large : breathless, raised RR, Hypoxia, Tachycardic, CXR trachea deviated
Parapneumonic , PH < 7.2 (caused by pneumonia)
Pus
Trauma/Post operative
when should you drain an effusion?
when it is large : breathless, raised RR, Hypoxia, Tachycardic, CXR trachea deviated
Parapneumonic , PH < 7.2
Pus
Trauma/Post operative
what does ‘the pleura’; consist of
single layer of mesothelial cells - line serous cavities and internal organs. Primary function - provides a slippery, non-adhesive and protective surface.
sub-pleural connective tissue
how many ml of pleural fluid usually found in the layers between pleura
2-3 ml
symptoms of a pleural effusion depend on what
cause and volume of fluid
a pleural effusion can be asymptomatic if…?
it is small and accumulates slowly
name some common symptoms associated with a pleural effusion
Increasing breathless (days, weeks, months)
Pleuritic chest pain
inflammatory: early, may improve as fluid accumulates
malignancy: progressively worsening
Dull ache
Dry cough – especially if rapid accumulation
Weight loss, malaise, fevers, night sweats
what are some clinical signs, in the chest area, of a pleural effusion?
on the effected side…
the chest should have fallen in (hear a stony dullness to percussion)
decreased breathsounds
decreased vocal resonance
what are some more general signs of a pleural effusion?
Clubbing
Chest examination - reduced expansion, breath sounds and vocal resonance. Stony, dull percussion
Cervical lymphadenopathy -enlarged nodes
increased jugular venous pulse JVP
Trachea away from large effusion (if unchanged? collapse)
Peripheral oedema
what can is a pleural effusion classified into by its protein concentration?
transudate or exudate
causes of transudate?
An imbalance of hydrostatic forces influencing the formation and absorption of pleural fluid.
Normal capillary permeability.
Usually (not always) BILATERAL
increase in venous pressure (cardiac failure, constrictive pericarditis, fluid overload)
causes of exudates
increased permeability of pleural surface and/ or local capillaries
basically leakiness of pleural capillaries secondary to infection, inflammation or malignancy ie pneumonia, TB, pulmonary infarction
usually UNILATERAL
what is a transudate?
filtrate of blood
caused by increased pressure in the veins and capillaries that forces fluid through the vessel walls
what is an exudate?
a mass of cells and fluid that has seeped out of blood vessels or an organ, especially in inflammation
classically, a pleural fluid protein level >30g/l is…
an exudate
classically, a pleural fluid protein level <30g/l is…
a transudate (proteins not pushed out as can’t fit between endothelial cells)
a transudate can very commonly come about from which health problems
anything that changes pressure in vessels
left ventricular failure - blood flowing back to pulmonary arteries - increase in pressure - fluid forced out due to this
liver problems
Peritoneal dialysis
an exudate can very commonly come about from which health problems
usually inflammatory - endothelial cells more spaced out due to inflammation - more proteins can be forced out with the fluid
Malignancy (lung, breast, mesothelioma, metastatic) Parapneumonic effusion (as a result of pneumonia)
