Pleural Disease Flashcards
What is a Pleural Effusion
A build up of excess fluid between the layers of the pleura outside the lung (often basally)
What are some causes of Pleural Effusions (x5)
Leaking from other organs Lung cancer Infections (pneumonia/TB) Autoimmune conditions Pulmonary embolism
What are symptoms of a pleural effusion
S.O.B
Pleuritic pain
Fever
Cough
BUT COULD BE NO SYMPTOMS
What tests can be used to check for pleural effusion
X-ray
CT scan
Ultrasound
What will an X-ray with pleural effusion show
Loss of Costo-phrenic angle
Concave or horizontal fluid level
Tracheal deviation
Opacity
What does Straw coloured pleural fluid indicate
Normal
What does Cloudy coloured pleural fluid suggest
Exudate it present, suggesting infection
What does Blood in the pleural fluid suggest
Malignancy
Tuberculosis
Trauma
Myocardial Infarction
What does pus in the pleural fluid suggest
Empyema
What is Empyema
Empyema is defined as a collection of pus in the pleural cavity, gram-positive, or culture from the pleural fluid. Empyema is usually associated with pneumonia but may also develop after thoracic surgery or thoracic trauma.
What two categories can Pleural effusions be split into
Transudative
Exudative
What are features of transudative pleural effusions
The fluid present is similar to normal pleural fluid as it forms from liquid leaking across the normal pleura.
Usually doesn’t need to be drained
Caused by organ failure
Whats the most common cause of transudative pleural effusions
Congestive Heart failure
What are features of Exudative pleural effusions
The fluid forms from extra liquid, blood, protein etc that leak across damaged blood vessels into the pleural cavity
May need to be drained
What the most common causes of exudative pleural effusions
Pneumonia
Lung cancer
What can be done to directly treat the pleural effusion
Tube Thoracotomy
When should you do a Tube Thoracotomy
If pleural effusion is large If patient is/has: - breathless -Tachycardic - Increased respiratory rate -Hypoxic -Deviated trachea
What should you do if the pleural effusion keeps returning after treatment
Consider using a long term catheter in pleural space which can drain pleural effusion at home
What is an exudative effusion associated with pneumonia called
A parapneumonic effusion
When should you drain a parapneumonic effusion
If pH<7.2
What is a Pneumothorax
A pneumothorax is a collapsed lung. Its occurs when air leaks into the space between your lung and chest wall. This air pushes on the outside of your lung and makes it collapse
How can you categorise Pneumothorax
Spontaneous (primary and secondary)
Traumatic (Iatrogenic and Non-Iatrogenic)
Tension
What are features of a primary spontaneous pneumothorax
No pre-existing lung disease
Usually men aged 15-30
Tall thin cannabis smokers
A small air bubble on the lung ruptures
What are features of a Secondary spontaneous pneumothorax
Arise from lung disease (injury to the pleura)
Usually men aged >55
High recurrence rate
How to you manage a pneumothorax
Depending on Patient History, the size of the pneumothorax, the breathlessness of the patient, either:
Aspirate
Discharge them
Chest drain
Admit to hospital
What is a tension pneumothorax
A large pneumothorax that causes cardiorespiratory compromise
What can you do if the pneumothorax is not resolving
Send home with chest drain
Medical pleurodesis
Cardiothoracic referral
What is Medical pleurodesis
Pleurodesis is a medical procedure in which the pleural space is artificially obliterated. It involves the adhesion of the two pleurae.
What are the clinical signs of a tension pneumothorax
Patient distressed Trachea deviated Subcutaneous emphysema Reduced chest expansion Hyper resonance Tachycardia
What should you do if patient has a tension pneumothorax
EMERGENCY
Give oxygen
Aspirate in the 2nd intercostal space in the mid clavicular line and insert chest drain
Chest Xray and Ultra sound - post drain
What are the main cause of transudative pleural effusion
Congestive heart failure renal/liver failure Hypoalbumineuria Meigs syndrome Hypothyroidism
What is meigs syndrome
right sided pleural effusion with ovarian malignancy
