pleural diseases Flashcards
- ACUTE INFLAMMATION OF THE
PARIETAL PLEURA - CHARACTERIZED BY A SHARP,
LOCALIZED, AND FLEETING PAIn
pleuritis
causes of pleuritis
- INFECTIONS: BACTERIAL, VIRAL, OR
FUNGAL INFECTION/PNEUMONI
pleuritis DX
- MADE CLINICALLY.
- CHEST X-RAY MAY BE NECESSAR
- SHARP, LOCALIZED CHEST PAIN
- EXACERBATED BY COUGHING, DEEP BREATHING, MOVEMENT, OR
SNEEZING - PAIN MAY RADIATE TO THE IPSILATERAL SHOULDEr
pleuritis sxs
pleuritis treatment
- TREAT UNDERLYING CAUSE
- NSAIDS
- CODEINE OR OTHER OPIOIDS MAY BE BENEFICIA
Abnormal accumulation of fluid in the pleural space (between
visceral and parietal pleura).
pleural effusion
associated with bacterial pneumonia,
bronchiectasis, or lung abscess
Parapneumonic effusion
fluid is anatomically confined within a sac
(not free flowing) in the pleural space. Due to adhesions
between visceral and parietal pleura
Loculated effusion:
accumulation of fluid between the lung
and diaphragm. Gives a false impression of an elevated hemi-
diaphragm
Sub-pulmonic effusion
alteration in hydrostatic and oncotic pressure
transudative
alteration in pleural permeability
exudative
- Caused by increased hydrostatic or decreased oncotic pressure
- Causes: CHF, atelectasis, renal disease, liver disease
- Pleural fluid characteristics:
- Protein:serum protein < 0.5
- LDH: serum LDH < 0.6
- LDH < 2/3 upper limit of normal for serum LDH
- Intervention: treat underlying caus
transudative
- Caused by leaky capillaries.
- Causes: infection, malignancy, trauma
- Pleural fluid characteristics:
- Protein to serum protein >0.5
- LDH to serum LDH > 0.6
- LDH > 2/3 upper limit of normal for serum LDH
- Intervention:
- Drainage with consideration for placement of indwelling pleural catheter
- Pleurodesis for refractory cases (recurrence >2 or 3)
exudative
- Caused by infection in the pleural space
- Causes
- Infection
- Pleural fluid findings:
- Increased WBC count
- Intervention:
- Drainage
- Antibiotics
empyema
- Caused by bleeding into pleural space
- Causes
- Trauma
- Malignancy
- PE
- Pleural fluid findings:
- Blood
- Pleural fluid to blood hematocrit ratio of > 0.5
- Intervention:
- Drainage as needed
hemothorax
- May be asymptomatic
- Pleural inflammation leads to pain. Pain can be referred
(phrenic nerve) to peripheral locations (shoulder) - Dyspnea.
o May be out of proportion to the size of the effusion
o Orthopnea is uncommon in the absence of CHF - Cough
- Absent or diminished movements on affected side
- Fullness of chest with bulging intercostal spaces
- Diminished breath sounds over the effusion
- Decreased or absent tactile fremitus
- Dullness to percussion
- Absence of breath sounds over effusion
- Absent vocal resonance
- Pneumonia-like findings such as crackles
pleural effusion
pleural effusion diagnostics
CXR in left lateral decubitus
thoracentesis
lights criteria
- pleural fluid to serum total protein ratio more than 0.5
- pleural fluid to serum LDH ratio more than 0.6
- pleural fluid LDH more than two third of serum LDH
at least one of these present means exudative
pleural effusion tx
thoracentesis
transudate tx
- resolves ties resolution of underlying condition
- diuretics/sodium restriction
exudate tx
treat underlying condition
empyema tx
drainage and abx
presence of air in pleural space
pneumothorax
primary pneumothorax
No pre-existing lung disease
FROM PENETRATING TRAUMA, LUNG
INFECTIONS, CARDIOPULMONARY
RESUSCITATION, POSITIVE PRESSURE
MECHANICAL VENTILATION
tension pneumothorax
BLUNT OR PENETRATING TRAUMA
traumatic pneumothorax
secondary pneumothorax
Pre-existing lung diseas
- INDUCED BY MEDICAL PROFESSIONALS
- THORACENTESIS, PLEURAL BIOPSY,
SUBCLAVIAN OR INTERNAL JUGULAR VENOUS
CATHETER PLACEMENT
iatrogenic pneumothorax
- NO UNDERLYING LUNG DISEASE
- AFFECTS MAINLY TALL, THIN BOYS
AND MEN BETWEEN 10 TO 30
YEARS - RUPTURE OF SUBPLEURAL APICAL
BLEBS FROM INCREASED
NEGATIVE INTRAPLEURAL
PRESSURE - CIGARETTE SMOKING, FAMILY
HISTORY ARE IMPORTANT RISK
FACTOR
primary pneumothorax
- OCCURS IN THE SETTING OF
UNDERLYING LUNG DISEASE - MORE LIFE-THREATENING
- COPD (MC), ASTHMA, INTERSTITIAL
LUNG DISEASE, CYSTIC FIBROSIS,
TUBERCULOSIS, PNEUMOCYSTIS
PNEUMONIA, MENSTRUATION - PNEUMOCYSTIS PNEUMONIA IS A
RISK FACTOR FOR
PNEUMOTHORAX
secondary pneumothorax
- DUE TO HIGHER PRESSURE OF AIR IN
THE PLEURAL SPACE COMPARED TO
AMBIENT AIR - CHECK-VALVE MECHANISM ALLOWS AIR
TO ENTER THE PLEURAL SPACE ON
INSPIRATION - AIR CANNOT EXIT THE PLEURAL SPACE
- LUNGS, TRACHEA, GREAT VESSELS, AND
HEART ARE PUSHED TO THE
CONTRALATERAL SIDE - LIFE-THREATENING
- PENETRATING TRAUMA, LUNG
INFECTION, CARDIOPULMONARY
RESUSCITATION, POSITIVE-PRESSURE
MECHANICAL VENTILATION
tension pneumothorax
- Sudden onset of chest pain
- Dyspnea
- Cough
- Life-threatening respiratory failure
Symptoms
* Decreased breath sounds
* Hyperresonance
* Decreased or absent tactile fremitus
* Mediastinal or tracheal deviation: tension
pneumothorax
* INCREASED JVP, PULSUS PARADOXUS,
HYPOTENSION
Signs
pneumothorax sxs
pneumothorax diagnostics
chest xray
primary pneumothorax treatment (small: <2)
close observation (6 hrs)
Oxygen
primary pneumothorax treatment (large: >2)
needle aspiration then
chest tube
secondary pneumothorax TX
chest tube
tension pneumothorax tx
- needle aspiration with large bore needle in 2nd or 3rd intercostal space
- then chest tube
