Pleural diseases

Question 1

What is the pleura?

Answer 1

A serous membrane that folds back on itself to form a two layered membranous sac that surrounds the lungs

Question 2

What is the name of the two layers?

Answer 2

Inner layer = Visceral

Outer layer = Parietal

Question 3

How far above the lungs does the pleura project?

Answer 3

3cm above the clavicle

Question 4

When doing a chest drain where should you stick the needle? Why?

Answer 4

Just above the rib, because just below the rib is where the nerves and blood vessels are

Question 5

What does the pleura do?

Answer 5

Protects the lung

Allows friction-free movement of the lung against chest wall

Not really that vital in humans

Question 6

How much fluid is there usually in the pleural cavity?

Answer 6

A tiny amount

Question 7

What is in the pleural fluid?

Answer 7

Protein: mainly albumin

A few cells

Question 8

List some pleural diseases

Answer 8

Pleural effusion
Pleural thickening
Pleural plaques
Pleural malignancy
Pleurisy

Question 9

What is pleural effusion?

Answer 9

Fluid in the pleural space

Question 10

What type of fluids can cause a pleural effusion?

What criteria is used?

Answer 10

Transudates: protein poor fluid
Exudates: protein rich fluid
(Light’s criteria)

Haemothorax: blood

Empyema: pus

Chylothorax: chyle (lymph + fat)

Haemopneumothorax: blood and air

Question 11

What causes a transudate pleural effusion?

Answer 11

Heart failure
Liver failure
Renal failure
Thyroid failure
Nutritional failure (low protein from diet)

Question 12

What causes an exudate pleural effusion?

Answer 12

Increased leakiness of pleural capillaries secondary to infection, inflammation or malignancy

So proteins leave capillaries and enter pleural cavity

Question 13

What are the symptoms of a pleural effusion?

Answer 13

Asymptomatic
Pleuritic chest pain
SOB

Question 14

What are the signs of a pleural effusion?

Answer 14

Reduced chest wall movement
Dull to percussion
Absent breath sounds
Reduced vocal resonance

Question 15

Investigation of pleural effusion.

Answer 15

X-ray: cloudy

Diagnostic pleural fluid aspiration: take a sample and see what is in the fluid

Pleural biopsy

CT

Question 16

When does a pleural effusion become visible on an X-ray?

Answer 16

When there is more than 500mL of fluid present

Question 17

Management of a pleural effusion?

Answer 17

Exudate: drain

Transudate: treat underlying cause

Question 18

What happens after you drain a pleural effusion caused by a malignancy?

How can you solve this problem?

Answer 18

It usually re-accumulates

Aspirate to dryness and then install a sclerosing (drying) agent such as talc, tetracycline

Question 19

What is DPT?

Answer 19

Diffuse pleural thickening

A lung disease in which extensive scarring thickens the pleura, the thin membrane that covers the lungs.

As the scar tissue grows, it can encase the lung and close off the space between the lungs and pleura.

Question 20

What causes DPT?

Answer 20

Asbestos exposure mainly

Infection
Trauma
Lupus
Many more

Question 21

Can you treat DPT?

Answer 21

No, not really

Question 22

What complications can from DPT?

Answer 22

Malignant mesothelioma

Question 23

What is the most important type of pleural malignancy?

Answer 23

Malignant mesothelioma

Question 24

What is pleurisy?

Answer 24

Inflammation of the pleurae, which impairs their lubricating function and causes pain when breathing.

Question 25

Cause of pleurisy?

Answer 25

Most commonly, infection

PE

Question 26

Symptoms of pleurisy?

Answer 26

Sharp pleuritic chest pain

Worsens inhalation and coughing

Question 27

Treatment of pleurisy?

Answer 27

Treat underlying cause

NSAIDs for pain relief

Drain fluid if it gets too much