Pleural Disease and Disorders Flashcards

1
Q

what symptoms and characteristics are seen with pleural effusion

A

symptoms

  • dyspnea
  • pleurisy
  • chest pain
  • asymptomatic
  • symptoms from underlying cause

Exam

  • decreased breath sounds
  • dullness to percussion
  • decreased or absent tactile fremitus
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2
Q

why do pulmonary function tests improve less than expected with Pleural fluid removal?

A
  • Pleural fluid expands the chest wall (not only decreasing lung volume)
  • atelectatic lung slow to expand
  • underlying lung disease
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3
Q

protein rich, implies pathologic changes in pleural membrane and capillaries leading to increased permeability

A

exudate

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4
Q

protein poor, implies changes in micovascular hydrostatic or oncotic or pleural pressures, can also occur by translocation of ascitic fluid

A

transudate

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5
Q

the criteria for an exudate is met if any of these three things are met?

A
  • 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
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6
Q

Causes of transudate?

A
  • left ventricular failure (blame the heart)
  • liver cirrhosis
  • nephrotic syndrome
  • hypothyroidism
  • mitral stenosis
  • hypoalbuminemia
  • urinothorax

WBC < 1000mm

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7
Q

causes of exudate?

A
  • malignancy
  • tuberculosis
  • pulmonary embolism
  • rheumatoid arthritis
  • benign asbestos effusion
  • pancreatitis
  • post MI or CABG
  • drugs

Most exduates: WBC > 1000mm

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8
Q

what is the colors of fluid of most transudates and exudates?

A

clear straw colored, non-viscid and odorless

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9
Q

causes of blood pleural fluid?

A
  • Hct < 50% peripheral Hct: cancer, pulmonary embolism, trauma
  • Hct > 50% peripheral hct: hemothorax
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10
Q

causes of cloudy or clear supernatant pleural fluid?

Cells, Debris, or lipids

A
  • 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
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11
Q

causes of Viscid pleural fluid?

A

empyema (likely foul smelling too)

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12
Q

what is lights criteria?

A
  1. ratio of pleural fluid protein to serum protein > 0.5
  2. ratio of pleural fluid LDH to serum LDH > 0.6
  3. pleural fluid LDH > 2/3 the upper limit of normal for serum LDH
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13
Q

if there is a neutrophil predominance in pleural fluid think…

A

acute process

  • Parapneumnoic
  • pancreatitis
  • pulmonary embolism
  • early tuberculosis
  • subphrenic abscess
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14
Q

if there is a lymphocyte predominance in pleural fluid think…

A
  • malignancy and tuberculosis
  • long standing effusions tend to become lymphocytic: Chronic RA pleuritis, late post-cardiac injury syndrome
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15
Q

if there is an eosinophilia predominance in pleural fluid think….

A
  • 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
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16
Q

what is not clinically significant in transudates?

A

neutrophilia and lymphocytosis are not clinically signficant

17
Q

what medications can cause pleural effusions?

A

nitrofuantoin
dantrolene
methotrexate
dilantin
amiodarone
beta blockers

18
Q

symptoms of a pneumothorax? what would you see on physical exam

A

Symptoms

  • chest pain, self limited
  • dyspnea
  • asymptomatic

PE

  • Decreased breath sounds
  • decreased chest excursion
  • hyperresonace to percussion
  • decreased or absent tactile fremitus
19
Q
  • No known lung disease
  • rupture of apical subpleural blebs due to shear force
  • patients tall and young
A

primary pneumothoracies

20
Q

what is considered a secondary pneumothoracies?

A

underlying lung disease (eg. COPD)

21
Q

What is considered iatrogenic pneumothoracies?

A

Caused by physicians

22
Q

what is considered traumatic pneumothroacies?

A

Associated with chest wall trauma: penetrating (GSW) or non penetrating (broken rib)

23
Q

physiologic effects of a pneumothorax?

A
  • main effects are decrease in VC and PaO2 due to atelectatic lung tissue
  • usually well tolerated in a healthy person. In persons with impaired lung function, may lead to respiratory insufficency
  • a small or moderate pneumothorax will have little effect on lung function
24
Q
  • air enters the pleural space during inspiration and then is trapped during expiration due to ball valve physiology
  • may impair hemodynamics due to decrease in venous return caused by the increased pleural pressures
A

Tension pneumothorax