Pleural diseases Flashcards
What are the most common cause of non-inflammatory pleural effusions? Inflammatory?
Non:
- congestive heart failure
- ruptured aortic aneurysm
Inflammatory:
- bacterial infections
- collagen vascular disease
Pleuritic can be caused by___?
Bacteria infections Rheumatoid arthritis Lupus erythematosis Uremia Radiation Pulmonary infarcts
Empyema is a complication of ___. What is it?
Pneumonia
Pus in the pleural space
Asbestos exposure characteristics
Localized diaphragmatic/pleural plaques (sometimes with calcification) ***
Pleural effusions
Interstitial fibrosis
How do you look for asbestos fibers?
Iron stain
What does malignant mesothelioma look like?
Adenocarcinoma (most often confused with this) and sarcoma
Differentiate via EM and immunohistochemistry
Where does malignant mesothelioma arise from
Pleural
Peritoneum
What are the mediastinal borders
Superior: superior thoracic inlet Inferior: diaphragm Lateral: pleura Anterior: sternum Posterior: spine
Anterior mediastinal tumors
Thymoma, teratoma, lymphoma, thymus
Carcinoid, metastatic carcinoma, lipoma
Middle mediastinal tumor
Sarcoma of the heart/pleura, lymphoma
Posterior mediastinal tumor
Mostly neurogenic tumors: schwanoma, neurofibroma, ganglioneuroblastoma
What is a thymoma. What are symptoms of a thymoma
Tumor arising from epithelial cells in thymus. Lymphocytes are bystander cells (benign part)
Has a dense fibrous capsule
Symptoms due to mass effect Hoarseness Dysphagia Dyspnea, cough Chest pain
Three types of thymoma (classification)
Typical: usually benign, can be aggressive
Atypical: indeterminate
Thymic carcinoma: malignant, aggressive
Typical thymoma
Small
Uniform
No necrosis or hemorrhage
No invasion through capsule
Thymic carcinoma
Large
Areas of necrosis or hemorrhage
Invasion through capsule
What is MG and what is it associated with
Deficient ACH receptor
65% of patients have thymic lymphoid hyperplasia
15% thymoma
___% of thymoma patients have ___. Tumors behave less aggressively with ___.
33%
MG
MG
Three types of mediastinal germ cell tumors
Benign-ish:
Teratoma
Malignant:
-Seminomatous
-Non-seminomatous (choriocarcinoma, embryonal carcinoma, malignant teratoma) elevated b-HCG and AFP
Thymic carcinoid
Rare, aggressive mediastinal tumor which metastasize adjacent mediastinal structures and lymph nodes
Mediastinal carcinoid
Aggressive
Histo: similar to pulm carcinoid
Tumor ‘nests’- location is key for diagnosis
Posterior mediastinal tumors
Benign:
Schwanoma
Neurofibroma
Glanglioneuroma
Malignant:
Ganglioneuroblastoma
Neuroblastoma
What are signs of a malignant tumor?
Invasion of capsule
Heterogenous changes
Transudative effusions
CHF
Cirrhosis
Nephrosis
Hypoalbumenia
Exudative effusions
Infection - bacterial, fungal, TB Malignancy - carcinoma, lymphoma, mesothelioma Inflammatory disorders - pancreatitis, asbestos, uremia Connective tissue diseases - SLE, RA Pulmonary embolism
Pleural fluid analysis for uncomplicated, complicated parapneumonic effusion and empyema
Uncomplicated: pH 7.3+ LDH 1000 (occasionally)
Often loculated, no pus but active inflammation and infection - chest tube
Empyema
PH 1000 (often)
Drain with chest tube
What is pleurodesis
‘Gluing’ the parietal and visceral pleura together
Treatment option for pleural effusion
Primary or spontaneous pneumothorax is seen more often in __, possibly due to ___.
Tall, thin smokers in their early 20s
Sub pleural blebs
Secondary pneumothorax often due to
COPD
PCP infection
What are the symptoms and physical exam findings of a pneumothorax
Dyspnea, pleuritic chest pain
Decreased chest excursion on affected side
Decreased breath sounds
Hyper resonant percussion (not often found)
Tension pneumothorax CXR signs and PE findings
No lung striations
Deep sulcus sign
Polyps at neck feel like rice crispies
Lights criteria
Pleural fluid/ serum protein >0.5
Pleural fluid/serum LDH > 0.6
Pleural fluid LDH > 2/3 upper normal limit of serum LDH
