Pleural disease (Pleural effusion & pneumothorax) Flashcards
(16 cards)
What is the pleura?
The pleura is a double-layered membrane that surrounds the lungs and lines the chest cavity, providing protection and lubrication for smooth lung movement during breathing.
Two layers:
Parietal pleura → Outer layer attached to the chest wall and diaphragm.
Visceral pleura → Inner layer covering the lungs directly.
Pleural cavity (space between the layers) contains pleural fluid (lubrication to reduce friction).
Most fluid is produced by the parietal circulation (intercostal arteries) and reabsorbed by the lymphatic system.
What is pleurisy?
Pleurisy (or pleuritis) is inflammation of the pleura, the membrane surrounding the lungs and lining the chest cavity. This condition causes sharp, stabbing chest pain that worsens with breathing, coughing, or sneezing.
What are the clinical features of pleurisy?
Sharp pain aggravated by deep breathing or coughing
on examination, rib movement is restricted and a pleural rub ( rough, scratchy, grating leathery sound as inflamed pleura rub against each other) may be present
What is pleural rub?
A pleural rub (also called pleural friction rub) is a specific sound heard during auscultation (listening with a stethoscope) when the pleura (the lining around the lungs) becomes inflamed and rubs against the chest wall.
Don’t confuse with pericardial friction rub! To distinguish ask the pt to hold their breath briefly, if the sound continues its pericardial as the inflamed pericardial layers continue to rub together with each heart beat whereas a pleural rub stops when breathing stops.
What causes central chest pain?
Tracheal: infection
Cardiac: Acute myocardial infarction/ischaemia
Oesophageal: Osophagitis/rupture
Great vessels: Aortic dissection
What causes non-central chest pain?
Pleural:
infection: pneumonia, bronchiectasis, TB
Malignancy: lung cancer, mesothelioma
Pneumothorax
Pulmonary infarction
Chest wall:
Malignancy: Lung cancer, mesothelioma
Persistent cough
Muscle sprains
Bornholm’s disease
costochondritis
What are the causes of pleurisy?
Viral infections spreading from the lungs to the pleural cavity are the most common such as: Influenza (flu)
Coxsackievirus
Herpes simplex virus
Bacterial infections:
Pneumonia (bacterial or viral)
Tuberculosis (TB)
It may also occur in malignancy
What is the investigations for pleurisy?
- Physical examination
- Chest imaging:
CXR: If normal this doesn’t exclude a pulmonary cause of pleurisy
A preceding history of cough, purulent sputum and pyrexia is presumptive evidence of pulmonary infection which may not have been severe enough to produce a radiographic abnormality or which may have resolved before the CXR was taken
ultrasound of chest - Labs
Blood count for WBCs, CRP to check for infection - Sputum Culture and PCR Testing
- Pleural fluid analysis:
perform thoracentesis to analyze the pleural fluid. This helps determine the etiology of the effusion, differentiating between transudative and exudative causes.
What is the management of pleurisy?
Primary cause must be treated
NSAIDs
What is pleural effusion?
Abnormal collection of fluid in the pleural space resulting from excess fluid production or decreasing absorption or both
What is the mechanism of fluid accumulation?
- increased drainage of fluid into the space
- increased production of fluid by cells in the space
- decreased drainage of fluid from the space.
How does hydrostatic pressure play a role in pleural effusion?
Hydrostatic pressure: The pressure that pushes fluid out of the capillaries into the surrounding tissues.
Oncotic pressure (or colloid osmotic pressure): The pressure exerted by proteins (mainly albumin) that draws fluid back into the capillaries.
When hydrostatic pressure in the pulmonary capillaries increases (due to conditions like heart failure), this pushes more fluid out of the capillaries into the pleural space.
Left-sided heart failure is a common example. When the left side of the heart is not pumping effectively, it causes blood to back up in the pulmonary circulation, increasing the hydrostatic pressure in the capillaries of the lungs. As a result, fluid accumulates in the lungs and pleural space, leading to pleural effusion.
What are the types of pleural effusion?
Can be classified as transudative and exudative effusions.
Transudative: Result from systemic conditions affecting fluid balance e.g elevated pleural capillary pressure with heart failure and decreased serum oncotic pressure with hepatic cirrhosis and nephrotic syndrome. Clear, pale yellow fluid. (Low in protein and LDH)
(increased hydrostatic pressure or low oncotic pressure)
Exudative pleural effusions occurs when the pleural surfaces themselves are altered. Inflammation of the pleura leading to increased protein in the pleural space which is the most common. (e.g., pneumonia, malignancy, TB, pulmonary embolism).
Cloudy, turbid fluid due to cells (high in protein and LDH)
Often due to increased capillary permeability from infection, malignancy, or inflammation.
(inflammation and increased capillary permeability)
How can pleural effusion develop?
Normal pleural space contained approx 0.1mL/kg of fluid which represents the balance between hydrostatic and oncotic forces in the visceral and parietal vessels and extensive lymphatic drainage. Pleural effusions result from disruption of his balance.
What are the symptoms of pleural effusion?
Dyspnea (shortness of breath) – Most common.
Dry cough – Non-productive.
Pleuritic chest pain – Sharp pain worsened by breathing/coughing (if inflammation is present).
Fever – If due to infection (e.g., pneumonia, TB).
Weight loss & fatigue – Seen in malignancy or chronic disease.
Orthopnea & reduced exercise tolerance – In large effusions.
