Pleural Disease - Unfinished Flashcards
What type of cells make up the pleura?
Mesothelial cells
What is the net movement of any fluid that enters the pleural space?
It moves through the pleura space, through the visceral pleura and into the lungs
Which other organs (apart from the lungs) are covered by the pleura?
Liver, spleen and kidneys
What is a pleural effusion?
An abnormal collection of fluid in the pleural space
What are the possible symptoms of a pleural effusion?
Increasing breathlessness, pleuritic chest pain, dull ache, dry cough, weight loss, malaise, fevers and night sweats
What other conditions should be asked about if you suspect someone has a pleural effusion?
Peripheral oedema, liver disease, orthopnoea and PND
What are the signs of a pleural effusion?
On affected side there is: decreased expansion, stony dullness to percussion, a decrease in breath sounds and a decrease I vocal resonance.
Other signs: clubbing tar stained fingers, cervical lymphadenopathy, increased JVP, trachea is not central and peripheral oedema
What are the two main causes of pleural effusions?
Transudates and exudates
What is a transudate?
An imbalance of hydrostatic forces influencing the formation and absorption of pleural fluid
Are transudates typically unilateral or bilateral?
Bilateral
What is an exudate?
An increased permeability of the pleural surface and/or local capillaries
Are exudates typically unilateral or bilateral?
Unilateral
What amount of pleural fluid protein is considered to be a transudate?
<30g/l
What amount of pleural fluid protein is considered to be an exudate?
> 30g/l
What are the common causes of transudates?
Left ventricular failure, liver cirrhosis, hypoalbuminaemia and peritoneal dialysis
What are the common causes of exudates?
Malignancy (lung, breast, mesothelioma etc.) and Pulmonary embolism/infarction
What investigations might be done if a pleural effusion is expected?
Chest radiograph, CT scan of the thorax and pleural aspiration and biopsy
What is the drawback with using a chest radiograph to detect a pleural effusion?
At least 200ml of fluid is required before it is detectable on a chest X-Ray
What is the benefit of a CT scan?
It can differentiate between malignant and benign disease
What are the complications of a pleural aspiration?
Pneumothorax, empyema, pulmonary oedema, vagal reflex, air embolism, tumour cell seeding and haemothorax
Which laboratories would you send an effusion sample to?
Biochemistry, microbiology and cytology
What is the management of a pleural effusion?
Treatment of the cause, palliative (usually malignancy, pleurodhesis and if lung has re-expanded then chemical pleurodhesis
What is a pneumothorax?
Air within the pleural cavity
What are the two main categories of pneumothoraces?
Spontaneous and traumatic
What is meant by a primary pneumothorax?
A pneumothorax in which there is no clinically apparent disease
What is believed to be the cause of a primary pneumothorax?
The weight of the lung inducing development of apical blebs that rupture
What is the main cause of a secondary pneumothorax?
Pre-existing lung disease (COPD, asthma, TB, CF etc.)
What are the main causes of non-iatrogenic pneumothoraces?
Penetrating and blunt chest injuries
What are the main causes of latrogenic pneumothoraces?
Pleural aspiration/biopsy, subclavian vein cannulation, lung/liver/breast/renal biopsies and acupuncture
