Pleural Disease Flashcards
imaging used to see pleural effusion
- CRX
- ultrasound
- CT
loculation define
fluid in the pleural cavity that prevents the full expansion of lungs, making it difficult to breathe.
loculated pleural effusion define
when there is scarring and fibrosis as well as fluid, the fluid then gets trapped in pockets, preventing natural drainage. This type usually stays there for a long time.
what does granular or cloudy fluid in scan indicate?
it means that it could be pus = means that there is likely an infection
blood is also not a good sign
5 things to consider when looking at the effusion:
- cloudy?
- pH
- biochem (LDH, cholesterol, glucose, proteins, amylase, rheumatoid factor)
- microbiology (what stain of bacteria?)
- cytology (the study of cells - malignancy?)
transudate vs exudate
TRANSUDATE:
- fluid that leaks out from the capillaries due to high arterial pressure and therefore has low protein content
- protein <2.5
- LDH normal
- associated with cardiac/liver/renal failure, hypothyroidism, hypoalbuminemia, malignancy, constrictive pericarditis
- has to do with organ failure or things that drop plasma protein content and therefore even if you drain the fluid, it would return unless you solve the underlying cause.
EXUDATE:
- fluid that comes out of the capillaries due to impaired permeability, either due to damage or inflammatory response, and therefore has high plasma protein content
- protein >3.5
- LDH high
- associated with infection, malignancy, pulmonary embolus, rheumatoid arthritis, pancreatitis, drug related effusions, post MI, systemic lupus erythematosus
- you also need to figure out the cause and then take things further
define lung trap
when the fluids have already been drained but the lung has not quite rebounded back to position due to fibrosis, will normally resolve itself in a few days
define blind sampling and its use
when we suspect something about the effusion, we take a blind sample by sticking a needle inside. Here we would not know which part of the effusion we are actually taking from and there are some inaccuracies
when to drain a pleural effusion?
* you don’t drain when the patient is very frail and instead rely on PMH
- when it is a large effusion (can lead to breathlessness, tachypnoea, tachycardia, hypoxia, tracheal deviation)
- when it is parapneumonic effusion (pH<7.2), this type of effusion arises from pneumonic infection. It is basically a collection of pus that if left for a long time can lead to another infection and therefore needs to be drained.
- drain when there is pus
- drain if this is post-trauma or post-operative
Why can’t you drain more than 1L of effusion at a time
the lung expanding too fast will cause it to be filled with fluid, resulting pulmonary effusion.
what is surface anatomy the safe triangle
bounded at the sides by the lateral edge of pectoris major and lateral edge of lastissimus dorsi and at the bottom by the 5th intercostal space.
symptoms of parapneumonic effusions
- pus in the cavity
- dull percussion note
- reduced breath tone
- poor prognosis
2 causes of parapneumonic effusions
(usually from infections like pneumonia)
- poor hygiene
- prior dental procedure–> oral bacteria goes and infects the lungs
treatment of parapneumonic effusions
- IV antibiotics (a lot needed, and takes a long time to heal)
- chest drain (need this if the pH<7.2 and if the effusion is too big for antibiotics to handle by itsef)
- also make sure to make blood culture of the drained fluid to determine the strain
- surgery if there is uncontrolled sepsis or established effusion
symptoms of pneumonthorax
- gas in the pleural cavity and collapsed lungs
- tracheal deviation (drain the air if there is tracheal deviation)
- bulla
- quite simple to manage
