Pleural Diseases Flashcards
What does the parietal pleura cover?
Rib cage
Mediastinum
Diaphragm
What pulls the the visceral pleura inward?
Lungs elastic recoil
What pulls the parietal pleura outward?
Chest wall
Which way does the fluid flow in the pleural space? How much flows through here?
From the parietal pleura to the pleural space
5-10L
What are the two types of pleural effusions?
Transudative
Exudative
What are the two types of pneumothorax?
Spontaneous
Traumatic
What are the symptoms of a pleural effusion?
Cough
SOB
Pleuritic chest pain
What are the signs of a pleural effusion?
Hypoxia
Tachypnea
Dullness to percussion
What type of breath sounds are predominant with a pleural effusion?
Bronchial
What happens to the mediastinum with a pleural effusion?
Shifts away from the lung
What are the CXR findings of a pleural effusion?
- Dense lung opacification
- Blunting of the costophrenic angle
- Lung shifted upward
What is the best position for the patient to be in to detect a pleural effusion?
Left lateral decubitus
How helpful is a gross examination of pleural fluid?
Rarely helpful unless bloody or chylous
Why are pleural effusions smelly?
Anaerobic infections
What is examined with a thoracentesis?
- WBC
- pH
- Glucose
- Protein
- LDH
- Cultures
What is the pleural fluid/serum protein level for exudate?
Greater than 0.5
What is the pleural fluid/serum LDH level for exudate?
Greater than 0.6
What are the causes of transudate? (4)
CHF
PE
Cirrhosis
Nephrotic syndrome
(anything that decreases oncotic pressure, or increases hydrostatic pressure)
What are the causes of exudate? (4)
Tumor
Infection
Trauma
Inflammation
What is the pleural fluid analysis reveal for a pleural fluid?
pH less than 7.2
What can cause an increase in amylase in pleural fluid?
Pancreatitis
Esophageal rupture
What is the treatment for an empyema with a low pH (less than 7.2)?
Chest tube
What does a decreased glucose level in pleural fluid indicate?
Infection or neoplasm
What is a cholesterol effusion?
Presence of cholesterol crystals in pleural fluid caused by long standing chronic pleural effusions
What usually causes a chylothorax?
Milky effusion that has high lipid content, usually caused by trauma or neoplastic process
What is the pleural fluid HCT/Serum HCT of a hemothorax?
Greater than 0.5
What is chemical pleurodesis?
Administration of a sclerosing agent, irritant into the pleural space
What is the indication for a chemical pleurodesis?
Recurrent pleural effusions which initially responded to simple thoracentesis
What is usually used to a chemical pleurodesis?
Talc powder
Doxycycline
What is the indication for a pleural biopsy?
Persistent pleural effusions, especially when TB is suspected
What are the ssx of a pneumothorax?
SOB
Chest pain
Cough
What happens to the mediastinum with a pneumothorax?
Shifts toward unless tension, then away
When is a thoracostomy tube indicated for a pneumothorax?
Greater than 50%
What are the causes of pneumothorax?
- Emphysema
- ILD
- Eosinophilic granuloma
- CF
- Asthma
- Malignancy
What type of workup should be done in a patient with a new onset pneumothorax, without explainable cause?
Malignancy
What are the idiopathic causes of a pneumothorax?
- esophageal perforation
- Mechanical ventilation
What is mesothelioma?
Benign or malignant growths in the plural space d/t asbestos exposure
What are the common tumors that invade the pleural space?
Bronchogenic or carcinoma
What is type of pleural effusion is seen with malignancy?
Blood
What are the drugs that can cause SLE induced pleural disease?
INH
Procainamide
Hydralazine
What type of virus can cause pleural disease?
Coxsackie
