Pleural Diseases Flashcards
What are the two layers of the pleura?
Visceral pleura and Parietal pleura.
What is the primary blood supply for the visceral pleura?
Bronchial circulation.
Which nerves supply the parietal pleura?
Intercostal nerve and phrenic nerve.
What is the main function of serous fluid in the pleural cavity?
To lubricate the pleural surfaces and generate surface tension for thoracic cavity expansion during inspiration.
What regulates pleural fluid formation?
The balance of hydrostatic and oncotic pressures between the parietal and visceral pleura, and lymphatic drainage.
What is pleural effusion?
An excess quantity of fluid in the pleural space due to increased fluid formation or decreased fluid removal.
What are the classifications of pleural effusion based on Light’s criteria?
Transudate and Exudate.
What is the most common cause of transudative pleural effusion?
Congestive heart failure.
What are the diagnostic imaging options for pleural effusion?
Chest radiograph, ultrasound, and CT scan.
What is the first-line treatment for primary spontaneous pneumothorax?
Simple aspiration.
What is the hallmark of tension pneumothorax?
Positive pressure in the pleural space throughout the respiratory cycle.
What structures are located in the superior mediastinum?
Thymus, trachea, esophagus, aortic arch, brachiocephalic trunk, superior vena cava, and vagus nerve.
What is the most common cause of acute mediastinitis?
Direct invasion following surgical interventions.
What imaging modality is diagnostic of choice for acute mediastinitis?
CT scan.
What is the treatment for fibrosing mediastinitis?
Supportive treatment targeting underlying causes, often requiring biopsy for diagnosis.
What is Light’s diagnostic criterion for exudative pleural effusion?
Pleural fluid protein/serum protein ratio >0.5, Pleural fluid LDH/serum LDH ratio >0.6, or Pleural fluid LDH >2/3 the upper limit of normal for serum.
What is the most common cause of exudative pleural effusion in the US?
Parapneumonic effusion.
What is empyema?
A grossly purulent effusion associated with bacterial infections.
What are the symptoms of pleural effusion?
Chest pain, shortness of breath, dry cough, orthopnea, and lightheadedness if fluid volume is large.
What is a subpulmonic effusion?
A pleural effusion located beneath the lungs, often elevating the diaphragm.
How does malignancy cause pleural effusion?
By increasing vascular permeability or obstructing lymphatic drainage.
What is the most common malignancy causing pleural effusion?
Lung cancer.
What is pleurodesis?
A procedure to obliterate the pleural space by inducing inflammation and fibrosis with a sclerosing agent.
What is the main nerve supplying the diaphragm?
Phrenic nerve.
What is pneumothorax?
Air in the pleural space, causing partial or complete lung collapse.
What is the primary cause of primary spontaneous pneumothorax?
Rupture of apical pleural blebs.
What are the types of pneumothorax?
Spontaneous (primary and secondary), Traumatic, and Tension pneumothorax.
What imaging finding is typical in tension pneumothorax?
Mediastinal shift to the unaffected side.
What are the subdivisions of the inferior mediastinum?
Anterior, middle, and posterior portions.
What is Hamman’s sign in pneumomediastinum?
A crunching or clicking noise synchronous with the heartbeat.
What is the diagnostic hallmark of chylothorax?
Milky pleural fluid with triglyceride levels >110 mg/dL.
What is a bronchogenic cyst?
A congenital anomaly commonly found in the middle mediastinum.
What is the treatment for acute mediastinitis?
Mediastinal exploration, drainage, and broad-spectrum antibiotics.
What is the most common cause of transudative pleural effusion?
Congestive heart failure.
What imaging modality guides thoracocentesis?
Ultrasound.
What are the signs of pleural effusion on percussion?
Dullness on the affected side.
What are common symptoms of pleural effusion?
Chest pain, shortness of breath, dry cough, and orthopnea.
What is the treatment for a parapneumonic effusion with pH <7.20?
Chest tube thoracostomy (CTT).
Which cancers commonly cause malignant pleural effusion?
Lung cancer, breast cancer, and lymphoma.
What is pleurodesis used for?
To obliterate the pleural space by inducing pleural adhesion and fibrosis.
What causes chylothorax?
Disruption of the thoracic duct due to trauma or tumors.
What is the primary imaging finding in tension pneumothorax?
Mediastinal shift to the unaffected side.
What are the symptoms of primary spontaneous pneumothorax?
Sudden chest pain and shortness of breath.
What is pneumomediastinum?
Gas in the mediastinum.
What is the most common cause of acute mediastinitis?
Postoperative deep sternal infections.
What structures are in the superior mediastinum?
Thymus, trachea, esophagus, aortic arch, superior vena cava, and vagus nerve.
What are the regions of the mediastinum?
Superior, anterior, middle, and posterior.
What is the hallmark clinical sign of pneumomediastinum?
Hamman’s sign (a crunching noise synchronous with the heartbeat).
What is fibrosing mediastinitis?
Abnormal proliferation of collagen and fibrous tissue within the mediastinum.
What causes tuberculous pleuritis?
A hypersensitivity reaction to tuberculous protein.
What are the main findings of malignant mesothelioma on imaging?
Pleural thickening and a shrunken hemithorax.
What diagnostic test confirms malignant mesothelioma?
Image-guided needle biopsy or thoracoscopy.
What is the treatment for tension pneumothorax?
Immediate needle decompression followed by chest tube placement.
What is Meigs syndrome?
Pleural effusion and ascites associated with ovarian cancer.
What is the function of the phrenic nerve?
It supplies motor innervation to the diaphragm.
