pleural disease Flashcards
what is pleural effusion?
- abnormal collection of fluid in the pleural space
- common presentation on many diseases
- does not always require drainage or sampling
- large unilateral effusions should raise concern
what should you do when suspecting pleural effusion?
- history and examination
- PA CXR
- pleural aspirate (if not convincingly cardiac failure)
- biochemistry
- cytology
- culture
what does the appearance of the pleural fluid tell us?
- straw coloured e.g. cardiac failure, hypoalbuminaemia etc
- bloody e.g trauma, malignancy, infaction, infarction
- turbid/milky e.g. empyema
- foul smelling e.g anaerobic empyema
- food particles e.g oesophageal rupture
- bilateral - drugs, systemic path
what does the biochemistry test tell us?
transudates = protein <30 g/l»_space; heart failure, liver cirrhosis, hypoalbuminaemia, atelectasis, peritoneal dialysis
exudates = protein >30g/l»_space; malignancy, infection, pulmonary infarction, asbestos
(look for serious pathology)
fluid pH <7.3 suggests pleural inflammation (malignancy/ rheumatoid A). <7.2 requires drainage in infection
glucose = low in infection, TB, rheumatoid arthritis, malignancy, oesophageal rupture)
what does cytology and cell counts tell you?
- mostly looking for malignant cells
- lymphocytes - think TB and malignancy although any long standing effusion will eventually become lymphocytic
- neutrophils suggest acute process
why might biopsies be negative so often?
- wrong technique (don’t contain pleura)
- the involvement of pleural disease is discontinuous
- the effusion is ancilliary with malignancy but not malignant.
what is the advantage of a image (CT) guided cutting needle pleural biopsy?
- increases diagnostic sensitivity significantly
- no complications
what is mesothelioma?
- uncommon malignant tumour of the lining of the lung or very occasionally of the lining of the abdominal cavity
- likelihood of development increases with degree and length of time exposed to asbestos
- often takes 30-40 years to develop
- may cause breathlessness, chest pain, weight loss, fever, sweating and cough.
what are the treatments for mesothelioma?
- Pleurodese effusions
- Radiotherapy
- Surgery
- Chemotherapy
- Palliative care
- Report deaths to fiscal
Describe malignant pleural effusion.
- virtually all cancers may metastasise to the pleura especially lung, breast, upper GI, lymphoma, melanoma, ovary
- treatment; palliative care, pleural taps, drain, pleural catheters long term, surgical options
what are pleural catheters?
- allow patients to control their effusion and therefore symptoms
- inserted when malignant effusions
- may need overnight stay
- drain is designed to remain for life though some people will stop producing fluid.
- vacuum in drainage bottle that suctions pleural fluid
- complications include incorrect placement, bleeding, infection.
how do we predict survival time in malignant pleural effusion?
L - LDH (lactate dehydrogenase)
E - ECOG PS (eastern cooperative oncology group performance score)
N - neutrophil to lymphocyte ratio
T -tumour type
what is the treatment for malignant pleural effusion?
- dependant on underlying cause
- LVF -diuretics
- if infection then drain, antibiotics, possible surgery
- malignancy - drain, pleurodesis, long term pleural catheter
- unilateral effusions watched carefully
who is most likely to get a pneumothorax?
- tall thin men
- smokers’-cannabis smokers
- those with underlying lung disease
what is a primary pneumothorax?
- in normal lungs
- apical bullae rupture
- may be asymptomatic if moderately sized
