Pleural diseases Flashcards
What is the presentation of a patient suffering from pleural effusion?
- dyspnea
- gradual onset
- continuous & progressive
- alleviated by sitting & exacerbated by lying down
- productive cough with yellow sputum
- fever
What are the findings of physical examination in pleural effusion?
- ill patient in moderate respiratory distress
- decreased chest expansion
- dullness on percussion
- tachycardia
What will be present in lab examination of pleural effusion due to bacterial infection?
- leukocytosis
- increased neutrophil count
What is seen on x-ray?
blunted costophrenic angle
What should be done after diagnosis of pleural effusion?
- lateral view x-ray: if more than 10mm -> thoracentesis
What is the most important criteria for confirming presence of exudate?
LIGHT’S CRITERIA
- pleural LDH/serum LDH >0.6
- pleural protein/serum protein > 0.5
What are the causes of exudate?
- parapneumonic effusion or empyema
- malignancy
- asbestosis
- sarcoidosis
- autoimmune diseases (SLE, RA)
- pancreatitis
How is empyema diagnosed?
- positive gram stain or culture of pleural fluid
- pleural fluid pH <7.2 or pleural glucose <60
What are the causes of transudate?
- heart failure (high hydrostatic pressure)
- liver cirrhosis (high oncotic pressure)
- nephrotic syndrome
how should pleural effusion be treated?
- exudate & transudate -> treat cause & drain if symptoms are worsening
- transudate due to CHF -> diuretics
- recurrent or uncontrolled (malignancy) -> pleurodesis
- empyema -> drainage by chest tube -> VATS or thoracotomy if chest tube is not enough
if adenosine deaminase (ADA) is found in the pleural fluid what does it indicate?
TB
what do positive triglycerides indicate if found in pleural fluid?
chylothorax
What is asbestosis?
diffuse interstitial fibrosis of lung due to asbestos dust exposure -> restrictive lung disease
What will a patient suffering from asbestosis complain of?
- progressive dyspnea
- dry cough
- risk of superimposed infection
What physical signs are seen in asbestosis?
- clubbing
- contralateral tracheal deviation
- basilar crackles
- decreased chest expansion
- decreased tactile fremitus
How should asbestosis be diagnosed?
- pulmonary function test: FEV1/FVC normal or >70
- high resolution CT chest: sub pleural linear opacities & basilar fibrosis
How is asbestosis managed?
- stop exposure
- supportive measures
What are the complications of asbestosis?
- pulmonary hypertension
- right heart failure
- bronchogenic carcinoma (more common)
- mesothelioma
What are the types & presentation of pneumothorax?
- spontaneous: bleb rupture -> sudden chest pain & SOB
- tension: trauma -> sudden chest pain, SOB, hypotension, hypoxia, decreased chest expansion, decreased breath sound, hyper resonance, contralateral tracheal deviation, high JVP
How is the diagnosis of pneumothorax confirmed?
CXR
How is pneumothorax treated?
- tension: needle decompression (2nd intercostal space at midclavicular line) then chest tube
- spontaneous: 15% -> observe more than 15% aspiration
