Pleural Disease

Question 1

What is Pleural Effusion?

How does it present?

Answer 1

A collection of fluid abnormally present in the pleural space,.

Usually resulting from excess fluid production and/or decreased lymphatic absorption.

Presents:

• Dyspnea (SOB).
• Cough.
• Chest pain.

Question 2

Clinical signs of chest infection: Expansion.

How will it be affected?

Answer 2

Expansion will decrease.

Question 3

Clinical signs of chest infection: Trachea/Mediastinum.

How will it be affected?

Answer 3

They will move away from the effusion (if large enough)

Question 4

Clinical signs of chest infection: Percussion.

How will it be affected?

Answer 4

Will become stony dull.

(stony descriptor indicates fluid)

Question 5

Clinical signs of chest infection: Auscultation.

How will it be affected?

Answer 5

Will decrease.

However, you should be able to hear breathing sounds at the level of the effusion.

Question 6

Clinical signs of chest infection: TVF/VR.

(vocal resonance)

How will it be affected?

Answer 6

Will decrease.

(Because sound waves are poorly conducted through the fluid)

Question 7

What three things can you notice to indicate fluid in these lungs?

Answer 7

1. Can you see the hemi diaphragm?

• (indicated by the dashed line)
• Disappearance indicates fluid.

2. Is there dense white shadowing?
3. Does the shadowing creep up the side of the chest wall?

Question 8

After tapping a pleural effusion (thoracocentesis), what labs would you send the fluid to?

And for what tests?

Answer 8

To chemistry lab:

• Protein and LDH.
• Glucose.

To microbiology lab:

• MCS (microscopy culture sensitivity).
• TB cultures (AFBs)

To cytology lab:

• Staining to find cell types present.

Question 9

Pleural fluid is found with protein in it.

What are the two terms used to describe varying protein levels?

Answer 9

<25 g/L = transudate.

>35 g/L = exudate.

If 25-35 use Light’s criteria.

Question 10

Generally, what type of problems cause protein transudates and exudates?

What are some more specific examples of each?

Answer 10

Transudates (<25g/L):

• Generally, SYSTEMIC causes.
  
  • (the ‘failures’)
  • Heart failure.
  • LIver failure.
  • Renal failure.

Exudates (>35g/L):

• Generally, LOCAL causes.
  
  • Infection.
  • Tuberculosis
  • Cancer (malignancy).

Question 11

Pleural glucose. What are the normal values? (mmol/L)

Answer 11

Normal values = 3-5 mmol/L.

(meant to match plasma glucose levels)

Question 12

What causes low pleural glucose?

Answer 12

• Infection (most common),
• Malignancy,
• RA,
• Tuberculous,

(Low glucose indicates ‘something’ is using the glucose up)

Question 13

What is Empyema?

Answer 13

Pockets of pus that have collected inside a body cavity.

They can form if a bacterial infection is left untreated.

• The term empyema is most commonly used to refer to pus-filled pockets that develop in the pleural space.

Has a mortality rate of about 20%!