Pleural Diseases Flashcards
What is the difference between transudates and exudates?
Transudates = low protein content
Exudates = high protein content
What are the causes for pleural exudates?
- infections
- neoplastic
- hepatic
- renal
- inflammatory (RA, SLE, scleroderma)
What are some causes for pleural transudate?
- raised microvascular pressure
- reduced pleural surface pressure
- major atelectasis
What are 3 common causes for large pleural effusions?
(3 T’s)
Tumor
TB
Trauma
What is the M/C/C of transudative pleural effusion?
Heart failure (usually left & right) Effusion is usually bilateral.
What is Meigs-Salmon syndrome?
a) benign ovarian tumor
b) pleural effusion
c) ascites
Which anatomical structure is usually response for the chylothorax?
Thoracic duct (close to aortic arch and mid-esophagus and surgery to these two areas can cause chylothorax).
What are the radiographic differences between pleural effusion and empyema?
Empyema
- lenticular shape
- unilateral or asymmetric
- forms obtuse angle with chest wall
- thickened pleura (split pleural sign)
What are the 3 types of pneumothorax? And which one is the M/C?
1) Spontaneous M/C
2) Tension
3) Traumatic (iatrogenic)
How many and what types of spontaneous pneumothorax are there?
Which is the M/C?
1) Primary (M/C) – rupture of bleb
2) Secondary (eg. airflow obstruction, interstitial lung disease)
Which side is more common to develop primary spontaneous pneumothorax?
Right side
What is tension pneumothorax and which pop’n are most prone to develop it?
Intrapleural pressure becomes positive, compressing normal lung.
Usually seen in mechanically ventilated and chest trauma patients.
What are 2 radiographic findings seen with tension pneumothorax?
- diaphragmatic depression
- medastinal shift
Which pop’n is most likely to get traumatic pneumothorax?
Newborns
What is the normal allowed amount for apical capping?
<5mm
Apical capping exceeding 5mm is associated with which disease process?
Inflammatory disease (eg. TB)
What are the most likely benign differentials for a localized pleural tumor and which is M/C?
- Lipoma (M/C)
- Fibroma
- Hemangioma
- Neurofibroma
Fibrous localized tumors of the pleural M/C arise from which pleura?
Visceral pleura (87%)
True or false: smoking increases the risk for malignant mesothelioma.
False. It does not.
What are the 3 types of malignant mesothelioma and which one is M/C?
a. Epithelial (M/C)
b. Sarcomatous
c. Mixed
What are the M/C causes for pleural calcification?
HEATR
- Hemothorax
- Empyema
- Asbestosis
- Talcosis/TB
- Radiation
What is the M/C of acute mediastinitis?
Spontaneous or iatrogenic esophageal rupture (90%).
eg. Boerhaave syndrome
What is a key radiographic feature indicating perforation of the esophagus?
Pneumomediastinum
What is the M/C/C for chronic mediastinitis in the US?
Histoplasma capsulatum
Chronic mediastinitis is characterized by what feature?
Progressive proliferation of fibrous tissue within mediastinum that encases and obstructs vital structures.
A continuous diaphragm sign is suggestive of which condition?
pnumomediastinum
What is the M/C primary tumor of the anterior mediastinum in adults?
Thymoma (20%)
Thymomas M/C present unilateral or bilateral?
Unilateral
What is the M/C thymic carcinoma?
squamous cell carcinoma
Neuroendocrine tumors of the thymus originate in which cells?
Kulchitsky cells
What is the M/C extragonadal location for germ cell tumors (eg. teratoma)?
Mediastinum
Dermoid cysts contain mostly which embryological componenets?
Ectodermal (eg. skin, hair, cartilage)
What endocrine condition is often associated with the thymus?
Myasthenia gravis
Which malignant germ cell tumor is likely to be found in the anterior mediastinum?
Seminoma (seen in young men)
What is a very sensitive and specific method for determining an intrathoracic mass to be thyroid in nature?
Radionuclide w/ iodine
What is the M/C mediastinal mass of thyroid origin?
Benign multinodular goiter
What are the two variants of Castleman Disease and which one is M/C?
a) Hyaline vascular (M/C 90%)
- seen in children & young adults
b) Plasma cell (10%)
Castleman disease is known to overlap with which multicentric syndrome?
POEMS
What are the differentials for egg-shell calcifications?
- Silicosis
- Coal miners pneumoconiosis
- Sarcoidosis
- Lymphoma following radiation
- Idiopathic
- TB/Fungal infections
What is the M/C abnormality of the middle mediastinum?
Lymph node enlargement
What are the 2 classifications used for aortic aneurysms?
1) DeBakey
2) Stanford
What is the Standford classification for aortic aneurysms?
Type A = Affects Ascending Aorta and Arch
- requires surgical management
Type B = Begins Beyond Brachiocephalic vessels
- requires medical management
What is the DeBakey classification for aortic aneurysms?
Type 1: ascending & descending aorta
Type 2: ascending aorta
Type 3: descending aorta
What are some differentials for middle mediastinal masses?
- Lymph nodes
- Bronchogenic cyst
- Aortic aneurysm
- Carcinoma of bronchus
What are some differentials for posterior mediastinal masses?
- Aorta (aneurysm/tortous)
- Extramedullary haemopoiesis
- Neural tumor
- Hiatal hernia
- Bone tumor (metastases, myeloma etc.)
- Dilated esophagus
