Pleural disease: pneumothorax and pleural effusions Flashcards
where does the blood and nerve supply to the pleura come from?
which pleura has sensation, parietal or visceral?
blood supply: intercostal vessels
nerve supply: intercostal nerves and vagus
Parietal pleura has sensation
are the pleura covering the lungs connected? what does this mean for disease spread?
Right and left side are completely separate so disease should not spread
how much pleural fluid is normal to be found in the pleural cavity? what is its function?
5-10mL to lubricate and make movements smooth during inspiration and expiration
what is a pneumothorax? why can it cause a collapsed lung?
Presence of air in the pleural space. Intra-pleural pressure is negative (lower than alveolar and atmospheric pressure) so air gets sucked into cavity and can lead to partial or total lung collapse
what is a tension pneumothorax and why is it an emergency? how do we treat it?
Air gets sucked into the pleural space but it is not expired so air build up. It can displace the mediastinum and cause cardiac compromise.
Treatment: urgent needle decompression in 2nd intercostal space to relieve pressure.
Leads to cardiac arrest if not treated.
A 20-40 year old, male, tall, smoker with no underlying lung disease is at risk of what condition?
Primary spontaneous pneumothorax
A secondary spontaneous pneumothorax occurs in who?
Those with underlying lung disease, majority COPD.
Name some trauma induced causes of pneumothorax
penetrating chest wall injury
puncture from rib
rupture of bronchus or oesophagus
Name some iatrogenic induced pneumothorax
pace makers, CT guided lung biopsy, central line insertion, mechanic ventilation, pleural aspiration
A patient presents with sudden breathlessness and pleuritic chest pain which is worse on breathing. They are tachypnoeic and hypoxic with reduced breath sounds. What condition is likely?
pneumothorax
how do we measure a pneumothorax? If there was a 2cm gap in the pleural space, approximately how much lung function would be lost?
measure across from the chest wall to the lung contour. 2cm across of pleural space means 50% of lung function is lost.
how do we manage a pneumothorax?
depends on size and symptoms
- small <2cm = no intervention as can spontaneously resorb
- pleural aspiration = up to 1.5L of air can be aspirated
- chest drain = needed for most secondary pneumothoraxes, chest drain put into big bottle with liquid at the bottom to stop air flowing back in
- surgery = for persistent and recurrent pneumothorax
- general advice: smoking cessation, no air flight for 6 weeks after resolution, no scuba diving ever.
what is a pleural effusion?
collection of fluid in the pleural space - common
Differentiating between transudate and exudate effusions?
Transudate = <30g/L pleural protein. Transudate occurs when things fail (heart failure, cirrhotic liver disease, renal failure, myxoedema, ascites)
Exudate - >30g/L pleural protein. These are all related to inflammation, increased capillary permeability and impaired re-absorption (pneumonia is most common, cancer, TB, PE, benign asbestos effusion, pancreatitis, dressers syndrome, drug induced)
A patient presents with breathlessness, cough, pain & fever. They have stony dull percussion, quiet breath sounds and reduced wall expansion as well as reduced tactile and vocal fremitus. What is the likely condition?
pleural effusion
