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Respiratory > Pleural diseases > Flashcards

Pleural diseases Flashcards

1
Q

What is the structure of normal pleura

A

Glistening, smooth, thin membrane covers thoracic cavity & lung

Outer layer : Parietal Pleura

Inner Layer : Visceral Pleura

In between : Pleural fluid

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2
Q

What is pleural fluid

A

Straw coloured
0.26ml/kg/cavity
Used for filtration
Protein - 1.5-2g/dl

Few cells : macrophages, lymphocytes, mesothelial cells

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3
Q

What are the different pleural problems

A

Pleural effusion: Collection of fluid

Pneumothorax: Collection of Air

Mesothelioma: Pleural malignancy

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4
Q

What is the pathogenesis of pleural effusion

A

Collection of fluid in the pleural space

Imbalance between production and absorption

Absorption : Pleural lymphatics in the parietal pleura

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5
Q

What are the different types of effusion

A

Transudate - Non-inflammatory
Exudate - Inflammatory, Protein content 3g/dl

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6
Q

What is LIGHTS criteria for pleural effusion

A

Protein : Pleural fluid /serum fluid ratio > 0.5

LDH : Pleural fluid /serum fluid ratio > 0.6

Pleural fluid LDH > 2/3 rd ULN serum LDH

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7
Q

What are some common causes of transudates

A

Left ventricular failure
Livercirrhosis

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8
Q

What are the less common causes of tansudates

A

Hypoalbuminaemia
Peritoneal dialysis
Hypothyroidism
Nephrotic syndrome
Mitral stenosis

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9
Q

What are the rare causes of transudate

A

Constrictive pericarditis
Urinothorax
Meigs’ syndrome

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10
Q

What are the comon causes of exudate

A

Malignancy
Parapneumonic effusions
Empyema
Tb

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11
Q

What are the less common causes of exudates

A

Pulmonary embolism
Connective tissue disease
Benign asbestos pleural effusion
Pancreatitis
Post-myocardial infarction
Post-coronary artery bypass graft
Haemothorax, chylothorax

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12
Q

What are the rare causes of exudate

A

Yellow nail syndrome (and other lymphatic disorders eg, lymphangioleiomyomatosis)
Drugs (see table 2)
Fungal infections

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13
Q

What are the investigations for pleural effusion

A

US : more sensitive than CXR , mark site for aspiration, assess pleura, bedside

CXR : accessible , easy to interpret

CT Thorax : Complex effusions , visualising the pleura , vascular and mediastinal structures

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14
Q

How would you analyse pleural fluid

A

Aspiration : simple and safe, trained operator

Inspect the fluid

PH ( bedside ABG machine ), biochemistry, microbiology and cytology

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15
Q

What are the management options for pleural effusion

A

PH < 7.2 with pneumonia, pus or blood -> chest drain

Transudate: treat underlying cause, may not need CT imaging

Exudate : Unless cause identified will need further investigation for eg further imaging , and or pleural biopsy

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16
Q

What is the pathogenesis for pneumothorax

A

Spontaneous pneumothorax:
- weak area on lung surface
- BLEB
- rupture, leak air into pleural cavity

17
Q

What are different types of pneumothorax

A

Primary Spontaneous
Secondary Spontaneous
Traumatic
Latrogenic
Tension

18
Q

What is the presentation of pneumothorax

A

Sudden event
Chest pain or breathlessness
Tall thin young men
Underlying lung disease
History of biopsy /line insertion/mechanical ventilation

19
Q

What do the examinations show in pneumothorax patient

A

tachypneic
Hypoxic
Reduced chest wall movement & reduced/no breath sounds
Not uncommonly examination may be normal

20
Q

What are the investigations for pneumothorax

A

CXR
US
CT thorax

21
Q

What do the management options depend on

A

Size
Effect on patient
Trained operator and staff aftercare

22
Q

pneumothorax

What are the treatment options

A

Observe : small and patient well
Aspiration : over 2 cm in size , patient well
Chest drain insertion
Surgery : recurrent events, unresolving

23
Q

Where does a pleural aspiration take place

A

Safe triangle
2nd intercostal space midclavicular line

24
Q

What is the pathogenesis of pleural tumour

A

Benign- rare
Malignant pleural effusions common
Primary malignancy- Mesothelioma common

25
Q

What are the chracteristics of mesothelioma

A

Rare, aggressive
Affects- Men, (plumbers, electricians, shipbuilding , power plants, boilers, engines)

Inhaled asbestos fibres reach pleura & cause inflammation provokes tumour formation

26
Q

What are the symptoms/signs of mesothelioma

A

Breathlessness
Chest Pain
Weight loss
Clubbed , signs of a pleural effusion

27
Q

What are the investigations for Mesothelioma

A

CXR- pleural effusion, pleural based mass
CT Thorax and Biopsy: needed to stage

28
Q

What is shown in the investigations for mesothelioma

A

Thickened pleura
Pleural nodules or masses
Pleural plaques
Effusion
Soft tissue infiltration

29
Q

What are the management options for mesothelioma

A

Treating effusion
Chemotherapy
Recruitment to trials via MDTs
Palliative surgery in select patients

Respiratory (30 decks)

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