Pleural Disease Vignettes

Question 1

Transudative pleural fluid formula

Answer 1

Due to extra-pleural

Heart failure, cirrhosis, hypoalbulinemia, neophrotic syndrome

Question 2

Pleural effusions due to CHF

Answer 2

81% bilateral but may not be equal in size

Question 3

Bacteiral pneumonia to empyema

Answer 3

May look for high LDH with low pH

Manage with a chest tube

Question 4

CHF and Nephrotic syndromes produce

Answer 4

Trnasudative effusions but have predisposition to pulmonary thromboembolism

Question 5

Important of treating pleural infection adequately

Answer 5

Can result in fibrothorax with trapped lung and restrictive impairment

Question 6

PE protocl

Answer 6

Give therapeutic heparin (unless contraindiciation) while awaiting dx testing

Question 7

TB effusions

Answer 7

Lymphocytic exudates…think over 90%

Cancer, TB, lymphoma or chylous effusion

TB stain does not need to be positive

Pleural TB is non-communicable but parenchymal is

Question 8

Thumatoid effusion

Answer 8

More in males

80% have subq nodules

Unilateral in most

May mimiic empyema with low glucose, low pH and high LDH

Alos look for tadpole-shaped histiocytes and giant cells

Question 9

PLeural plaques vs. late dz

Answer 9

Plauqes at supradiaphragmatic means exposure

Late - lung cancer and mesothelioma

Mesothelioma has a 25-45 year lag time

Question 10

Malignant meso

Answer 10

25-45 year lag

Chest pain and dyspnea

Progressive pleural dz

May be intraperitoneal

Need open biopsy

Question 11

Chylous effusion

Answer 11

Due to disruption of thoracic duct

Milky, high protein, lymphocytic with chylomicrons

Most common etiology is tumor (lymphoma) although could be TB

May mimic empyema but empyema should be neturophil prdom without chylomicrons