Pleural Disease Flashcards
Pleural effusion
Collection of fluid in the pleura
Tracheal deviation
Can be pushed by pleural effusion
Colour of normal pleural fluid
Straw
Cloudy pleural fluid
Exudate, infection
Blood in pleural fluid
Malignancy, TB, trauma, infarct
Pus in pleural cavity
Empyema
What is pleural fluid
Protein, LDH, glucose etc
How to look at the microbiology of pleural fluid
Gram stain, AAFB and culture
Transudate
Less than 2.5 G/dl of protein. Normal LDH. Is filtered, a collection signals organ failure/low albumin so you need to fix the organ not the fluid
Exudate
More than 3.5g/dl of protein and high LDH. A collection is a sign of an underlying probably respiratory problem or malignancy
Abrams pleural biopsy
Bedside with local anaesthetic, blind with low success rate for diagnosis
Image guided biopsy
Better success rate, with local anaesthetic for diagnosis
Medical thorascopy
Uses a camera, local sedation, higher success rate, used for pleurodesis not diagnosis
Vats pleural biopsy
Highest success rate, done under general anaesthetic with direct visualisation by camera, scars tissue after so it heals up
When to drain an effusion
Breathless, raised RR, hypoxia, tachycardia, CXR shows deviated trachea, parapneumonic, pH < 7.2, pus or trauma
What happens if you remove too much fluid out
The lung can fill with fluid, so take <1500mls
How to close the pleural space if recurrent
Spray talcum powder in it or have a permanent drain
Chest tube placement
5th intercostal space anterior to midaxillary line
Parapneumonic effusions
Up to 1/3 of all effusions, 10% are complicated eg pus, with poor outcome
Locules
Pockets of fluid
Treatment of parapneumonic effusions
Drain if ph <7.2, give IV abx, possibly surgery if poor control of sepsis
Traumatic pneumothorax
Can be iatrogenic or not, eg stabs or fractured ribs
Spontaneous pneumothorax
Can be primary (70-80%) especially in men 15-30 and smokers, with 25% recurrence
Or secondary, in older men especially and conditions like COPD, asthma, cancer, with a higher recurrence rate. Consider pleurodeisis
Management of pneumothorax
Do nothing, sometimes aspirate, give oxygen and chest drain
Tension pneumothorax treatment
Give oxygen, aspirate in 2nd anterior intercostal space in midclavicular line.
Discharging a pneumothorax
Advice about recurrence, smoking cessation, no flying
3 types of asbestos
Chrysotile(white)- most common
Amosite (brown)
Crocidolite (blue)- most dangerous
Latent period for asbestos related pleural disease
20-40 years
Pleural plaques
Marker of asbestos exposure, benign
Benign asbestos effusion
Exclusion diagnosis. Exudate, chronic but can resolve spontaneously, can cause thickening
Malignant mesothelioma
Cancer, causes chest pain, breathlessness, fever, weakness, cough, weight loss. Do CXR and CT, aspirate which will have blood and look at cells, need tissue to confirm (biopsy). Median survival less than a year, use chemo and pleurodesis and long term drain for palliation
