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Pulmonary Block > Pleural diseases > Flashcards

Pleural diseases Flashcards

1
Q

What are the most common cause of non-inflammatory pleural effusions? Inflammatory?

A

Non:

  • congestive heart failure
  • ruptured aortic aneurysm

Inflammatory:

  • bacterial infections
  • collagen vascular disease
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2
Q

Pleuritic can be caused by___?

A 
Bacteria infections
Rheumatoid arthritis
Lupus erythematosis
Uremia 
Radiation
Pulmonary infarcts
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3
Q

Empyema is a complication of ___. What is it?

A

Pneumonia

Pus in the pleural space

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4
Q

Asbestos exposure characteristics

A

Localized diaphragmatic/pleural plaques (sometimes with calcification) ***
Pleural effusions
Interstitial fibrosis

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5
Q

How do you look for asbestos fibers?

A

Iron stain

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6
Q

What does malignant mesothelioma look like?

A

Adenocarcinoma (most often confused with this) and sarcoma

Differentiate via EM and immunohistochemistry

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7
Q

Where does malignant mesothelioma arise from

A

Pleural

Peritoneum

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8
Q

What are the mediastinal borders

A 
Superior: superior thoracic inlet
Inferior: diaphragm 
Lateral: pleura 
Anterior: sternum
Posterior: spine
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9
Q

Anterior mediastinal tumors

A

Thymoma, teratoma, lymphoma, thymus

Carcinoid, metastatic carcinoma, lipoma

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10
Q

Middle mediastinal tumor

A

Sarcoma of the heart/pleura, lymphoma

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11
Q

Posterior mediastinal tumor

A

Mostly neurogenic tumors: schwanoma, neurofibroma, ganglioneuroblastoma

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12
Q

What is a thymoma. What are symptoms of a thymoma

A

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
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13
Q

Three types of thymoma (classification)

A

Typical: usually benign, can be aggressive
Atypical: indeterminate
Thymic carcinoma: malignant, aggressive

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14
Q

Typical thymoma

A

Small
Uniform
No necrosis or hemorrhage
No invasion through capsule

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15
Q

Thymic carcinoma

A

Large
Areas of necrosis or hemorrhage
Invasion through capsule

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16
Q

What is MG and what is it associated with

A

Deficient ACH receptor
65% of patients have thymic lymphoid hyperplasia
15% thymoma

17
Q

___% of thymoma patients have ___. Tumors behave less aggressively with ___.

A

33%
MG
MG

18
Q

Three types of mediastinal germ cell tumors

A

Benign-ish:
Teratoma

Malignant:
-Seminomatous

-Non-seminomatous (choriocarcinoma, embryonal carcinoma, malignant teratoma) elevated b-HCG and AFP

19
Q

Thymic carcinoid

A

Rare, aggressive mediastinal tumor which metastasize adjacent mediastinal structures and lymph nodes

20
Q

Mediastinal carcinoid

A

Aggressive
Histo: similar to pulm carcinoid
Tumor ‘nests’- location is key for diagnosis

21
Q

Posterior mediastinal tumors

A

Benign:
Schwanoma
Neurofibroma
Glanglioneuroma

Malignant:
Ganglioneuroblastoma
Neuroblastoma

22
Q

What are signs of a malignant tumor?

A

Invasion of capsule

Heterogenous changes

23
Q

Transudative effusions

A

CHF
Cirrhosis
Nephrosis
Hypoalbumenia

24
Q

Exudative effusions

A 
Infection 
- bacterial, fungal, TB
Malignancy 
- carcinoma, lymphoma, mesothelioma
Inflammatory disorders
- pancreatitis, asbestos, uremia
Connective tissue diseases
- SLE, RA
Pulmonary embolism
25
Q

Pleural fluid analysis for uncomplicated, complicated parapneumonic effusion and empyema

A

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

26
Q

What is pleurodesis

A

‘Gluing’ the parietal and visceral pleura together

Treatment option for pleural effusion

27
Q

Primary or spontaneous pneumothorax is seen more often in __, possibly due to ___.

A

Tall, thin smokers in their early 20s

Sub pleural blebs

28
Q

Secondary pneumothorax often due to

A

COPD

PCP infection

29
Q

What are the symptoms and physical exam findings of a pneumothorax

A

Dyspnea, pleuritic chest pain

Decreased chest excursion on affected side
Decreased breath sounds
Hyper resonant percussion (not often found)

30
Q

Tension pneumothorax CXR signs and PE findings

A

No lung striations
Deep sulcus sign

Polyps at neck feel like rice crispies

31
Q

Lights criteria

A

Pleural fluid/ serum protein >0.5

Pleural fluid/serum LDH > 0.6

Pleural fluid LDH > 2/3 upper normal limit of serum LDH

Pulmonary Block (7 decks)

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