Pleural Disease and Disorders Flashcards
what symptoms and characteristics are seen with pleural effusion
symptoms
- dyspnea
- pleurisy
- chest pain
- asymptomatic
- symptoms from underlying cause
Exam
- decreased breath sounds
- dullness to percussion
- decreased or absent tactile fremitus
why do pulmonary function tests improve less than expected with Pleural fluid removal?
- Pleural fluid expands the chest wall (not only decreasing lung volume)
- atelectatic lung slow to expand
- underlying lung disease
protein rich, implies pathologic changes in pleural membrane and capillaries leading to increased permeability
exudate
protein poor, implies changes in micovascular hydrostatic or oncotic or pleural pressures, can also occur by translocation of ascitic fluid
transudate
the criteria for an exudate is met if any of these three things are met?
- ratio of pleural fluid protein to serum protein > 0.5
- ratio of pleural fluid LDH to serum LDH > 0.6
- pleural fluid LDH > 2/3 the upper limit of normal for serum LDH
Causes of transudate?
- left ventricular failure (blame the heart)
- liver cirrhosis
- nephrotic syndrome
- hypothyroidism
- mitral stenosis
- hypoalbuminemia
- urinothorax
WBC < 1000mm
causes of exudate?
- malignancy
- tuberculosis
- pulmonary embolism
- rheumatoid arthritis
- benign asbestos effusion
- pancreatitis
- post MI or CABG
- drugs
Most exduates: WBC > 1000mm
what is the colors of fluid of most transudates and exudates?
clear straw colored, non-viscid and odorless
causes of blood pleural fluid?
- Hct < 50% peripheral Hct: cancer, pulmonary embolism, trauma
- Hct > 50% peripheral hct: hemothorax
causes of cloudy or clear supernatant pleural fluid?
Cells, Debris, or lipids
- cloudy supernatant on centrifugation: due to lipids as in a chlyothorax
- clear supernatant on centrifugation: due to cells and debris usually related to a pleural infection of malignancy
causes of Viscid pleural fluid?
empyema (likely foul smelling too)
what is lights criteria?
- ratio of pleural fluid protein to serum protein > 0.5
- ratio of pleural fluid LDH to serum LDH > 0.6
- pleural fluid LDH > 2/3 the upper limit of normal for serum LDH
if there is a neutrophil predominance in pleural fluid think…
acute process
- Parapneumnoic
- pancreatitis
- pulmonary embolism
- early tuberculosis
- subphrenic abscess
if there is a lymphocyte predominance in pleural fluid think…
- malignancy and tuberculosis
- long standing effusions tend to become lymphocytic: Chronic RA pleuritis, late post-cardiac injury syndrome
if there is an eosinophilia predominance in pleural fluid think….
- most commonly due to air or blood in pleural space
- otherwise non-specific: parapneumonic effusion, asbestos related effusion, eosinophilic pneumonia, drug induced, parasitic disease, churg-strauss syndrome
