Pleural Diseases Flashcards
What is pleura
It’s a serous membrane that covers the lung parenchyma, mediastinum, and diaphragm
What are the parts of the pleura
-cervical
-costal part
-mediastinal
-diaphragm
What is pneumothorax
-collection of air inside the plural cavity
What are the types of pneumothorax
-spontaneous
-acquired
What is the classification of spontaneous pneumothorax
-primary
-secondary
What is the cause of primary spontaneous pneumothorax
-rupture of the bleb in thin, tall, young patient
What is the cause of secondary spontaneous pneumothorax
-underlying pulmonary causes (COPD, asthma and cystic fibrosis)
-immunocompromised patients
What is the classification of acquired pneumothorax
-traumatic penetration
-iatrogenic (biopsy, CV catheter, thoracentesis)
-barotrauma
What are the risk factors of primary spontaneous pneumothorax
-male
-young age (15-30)
-tall and thin
-smoking
What is the side of rupture of bleb in primary spontaneous pneumothorax
-apex of upper lobe
-superior segment of lower lobe
What are the symptoms of primary spontaneous pneumothorax
-sudden onset of dyspnea
-pleuritic chest pain
What are the signs of primary spontaneous pneumothorax
-inspection: decrease of the chest movement
-palpation: <TVF
-percussion: hyperressorance
-auscultation: diminished breath sound
What is the indications of tube thoracotomy
-symptomatic PSP
-SSP
-tension pneumothorax
What is the indications of surgical in PSP
-recurrent pneumothorax
-massive air leak
-decrease lung expansion after tube thoracotomy
What is the definition of haemothorax
-blood in the plural cavity
What is the cause of haemothorax
-traumatic penetration
-iatrogenic (biopsy, CV catheter, thoracentesis)
What is the symptoms of haemothorax
-cough
-chest pain
-dyspnea
What is the signs of haemothorax in small amount
-normal physical examination
What is the signs of haemothorax in large amount
-inspection: decrease of the chest movement
-palpation: <TVF
-percussion: dullness
-auscultation: diminished breath sound
What is the X-ray findings of haemothorax in small amount
-obliteration of the costophrenic angle
What is the X-ray findings of haemothorax in large amount
-homogeneous opacity in obliteration of the costophrenic angel rising to the axilla
What is the X-ray findings of haemothorax if air fluid level is presence
-haemopneumothorax
What is the management of haemothorax
-restoration of blood volume
-decompression of the lungs by tube thoracotomy
What is the indication of tube thoracotomy in haemothorax
-persistent haemothorax (3-5)
-massive haemothorax (15)
-clotted pneumothorax
What is thoracic empyema
-pus in the pleural cavity
What is chronic empyema
-failure of chest expansion after drainage of the lung
What is the causative agents in empyema
-specific: TB
-non specific: anaerobes
What is the most common source of empyema in children
-pnemonia
What are the stages of parapneumonic plueral effusion
-exudative
-fibropurulent
-organising
What is character of exudative stage in parapneumonic plueral effusion
-increase fluid due to inflammation
What is character of fibropurulent stage in parapneumonic plueral effusion
-fibrin deposition leads to loculations
-infected fluid becomes thick and purulent
What is character of organising stage in parapneumonic plueral effusion
-firm granuloma formation
Rest for Question; Take note that the diagnosis of haemothorax is the same with empyema in case of symptoms, signs and x-ray but it has extra which is
Thoracentesis
During thoracentesis, foul smelling indicates
anaerobic
What are the criteria of thoracic empyema
-pus frank
-based on light criteria
List of light criteria based on:
-ph
-glucose
-ldh
-protein level
-WBC
-ph<7.2
-glucose<40
-ldh>1000
-protein level>3
-WBC>15000
What are the management of the empyema
-antibiotic therapy
-chest tube
-thoracoscopy
-rib resection
-decortication
-pulmonary resection
-thoracoplasty
What is given during the antibiotic therapy of empyema
-broad spectrum antibiotic
When is the early insertion of the chest tube in empyema
-before loculation of pleural effusion
When is the position of the chest tube in empyema
-based on the affected site
When is the recommended size of bore of the chest tube in empyema
large (34-40F)
What is the indication of thoracoscopy
-multiloculated empyema
What is the indication of rib resection
-ill patient that cannot tolerate to décortication
What are done during decortication of empyema
-removal of fibrous peels in visceral pluera
-opening fissures
-removal of thickened parietal pluera
what is the indication of pulmonary resection
-destruction of the lobes or the whole lungs
Combination of thoracoplasty and pedicle flap is used in case of what condition and why
-chronic empyema
-due bronchopleural fistula
What is pleural mesothelioma
-it’s cancer caused by prolonged exposure of asbestos
What is the most common type of mesethelioma
-pleural mesothelioma
What is the histological type of pleural mesothelioma
-epithelial
-sarcomatous
-mixed
What is the median survival rate of pleural mesothelioma
12-18
What is the treatment pleural mesothelioma
-surgical, chemotherapy, radiotherapy
-pleurodesis (gives relief)
What is chylothorax
-lymph in the pleura cavity
What is the cause of chylothorax
-congenital
-neoplasm as lymphoma
What is the investigation of chylothorax
-same with haemothorax
-aspiration; TGA:Cholesterol>1
What is the treatment of chylothorax
-chest tube
-right thoracotomy (ligation of thoracic duct)
-video surgery
What is the indication of right thoracotomy (ligation of thoracic duct) in chylothorax
-drainage >1500 per 5 days
