pleural disease

Question 1

Give some causes of transudate pleural effusion.

Answer 1

• fluid over load due to the failures:
• RH failure
• liver failure
• kidney failure (acute or chronic)
• protein loss enteropathy

Question 2

Give some causes of exudative pleural effusion.

Answer 2

• infection - pneumonias, TB, empyema
• Malignancy - lung Ca, breast mets, meso
• PE - cytokine release + increase vascular pressure
• Autoimmue disease

Question 3

How do you differentiate between transudative and exudative pleural effusion? What’s the criteria called?

Answer 3

Light’s criteria:
Exudative effusion if one or more is met of -
-fluid/serum protein ration >0.5
-fluid/serum LDH ratio is >0.6
-pleural LDH >2/3 the upper limit of serum LDH.

Question 4

What effusions have low glucose?

Answer 4

MEAT has low glucose 
Malignancy 
Empyema
Arthritis Rheumatoid
TB

Question 5

Which way does the trachea move when there’s an effusion present?

Answer 5

away

Question 6

What CXR findings would suggest an effusion?

Answer 6

• blunting of the costophrenic angles
• complete lung white out
• hemi thorax shift

Question 7

What other investigations could be done with someone presenting with a pleural effusion?

Answer 7

• USS - amount of effusion
• CT - gold standard - amount +/- cause
• Aspiration - type of effusion +/- therapeutic indication

Question 8

Management of a pleural effusion.

Answer 8

• therapeutic thoracocentesis
• treat underlying cause
• chest drain
• pleurodesis in recurrent pleural effusion

Question 9

What is a pneumothorax? 3 types?

Answer 9

air between the visceral and costal pleural

• spontaneous
• traumatic
• tension

Question 10

Tell me about spontaneous pneumothoraxes.

Answer 10

spontaneous pneumothorax
primary or secondary
primary = w/o underlying lung disease
secondary = w/ underlying lung pathology

Question 11

Important causes of traumatic pneumothorax.

Answer 11

• penetrating injury

- iatrogenic

Question 12

Define tension pneumothorax.

Answer 12

a tear in the pleura that causes a progressive increase in pressure in the chest cavity that will eventually lead to cardiorespiratory compromise. THIS IS LIFE THREATENING.

Question 13

Symptoms of pneumothorax?

Answer 13

• sudden onset pleuritis chest pain
• absent or hyper resonant breath sounds

Severe:

• reduced chest expansion
• distended neck veins
• haemodynamic instability

Question 14

CXR signs of a pneumothorax.

Answer 14

• Tracheal deviation away from the affected side
• loss of pulmonary vascular markings
• depressed hemidiaphragm
• black rim of air around a collapsed lung

Question 15

When and how do you treat a pneumothorax?

Answer 15

greater than 2cm in size
large bore canula - 2nd intercostal space - midclavicular line
chest drain if doesn’t improve/resolve/is recurrent