Pleural diseases: effusion + pneumothorax

Question 1

whats the pleura?

Answer 1

serous membrane that folds back on itself to form a 2-layered membranous pleural sac. Visceral and parietal

Question 2

topography of the pleura?

Answer 2

project 3cm above the clavicle. The even numbered-ribs: 2,4,6,8,10,12.
Horizontal to the lower border of 12th ribs.
Base of lung is 2 ribs higher than pleural reflection

Question 3

functions of the pleura?

Answer 3

1. Pleura allows movement of lung against chest wall
2. Coupling system between lungs and chest wall – elastic recoil and max neg pressure
3. Clearing fluid from the pulmonary interstitium

Question 4

what does pleural fluid contain?

Answer 4

protein (mainly albumin, globulin and fibrinogen), few cells mainly mesothelial cells, monocytes and lymphocytes

Question 5

what are the causes of pleural plaques?

Answer 5

benign + asbestos related

Question 6

whats a pneumothorax?

Answer 6

abnormal collection of air within cavity

Question 7

whats pleural effusion?

Answer 7

fluid in pleural space due to malfunction in production/absorption of fluid

Question 8

transudate

Answer 8

relatively low protein states

Question 9

exudates

Answer 9

higher protein concentration

Question 10

empyema

Answer 10

pus in pleural space

Question 11

chylothorax

Answer 11

chyle in pleural space (lymph with fat)

Question 12

what are transudate effusions caused by?

Answer 12

increased venous pressure or hypoproteinaemia

Question 13

what are exudate effusions caused by?

Answer 13

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

causes: pneumonia, tb, pulm infarction, RA, SLE

Question 14

Presentation of pleural effusion

Answer 14

decreased expansion, stony dull percussion note, diminished breath sounds on the affected side

tracheal deviation away from large effusions

pleuritic chest pain

Question 15

What would you look for in CXR for pleural effusion?

Answer 15

mass/mets?
consolidation?

completely flat horizontal upper border –> there is also a pneumothorax

Question 16

Use of ultrasound for pleural effusion?

Answer 16

to identify presence of pleural fluid + guide aspiration

Question 17

Whats thoracentesis?

Answer 17

also called pleural tap: removing air/fluid from the pleural space

biochem, appearance, transudate vs exudate

Question 18

if pleural protein is more than half of the serum protein, what is it?

Answer 18

an exudate

or if pleural LDH:serumLDH > 0.6

Question 19

if pleural fluid is straw coloured instead of clear, what is it?

Answer 19

an exudate

Question 20

Tx for pleural effusion

Answer 20

drainage

surgery: if persistent collections and increasing pleural thickness

Question 21

is marfrans syndrome a cause of primary or secondary spontaneous pneumothorax?

Answer 21

primary! (PSP)

Question 22

list 2 secondary causes of spontaneous pneumothorax

Answer 22

COPD, pulmonary fibrosis

Question 23

what does catamenial mean?

Answer 23

associated with menstruation

Question 24

signs of pneumothorax

Answer 24

reduced expansion
hyper-resonance to percussion
diminished breath sounds on affected side

Question 25

symptoms of pneumothorax

Answer 25

may be asymptomatic

or sudden onset of dyspnea and/or pleuritic chest pain

Question 26

CXR penumothorax

Answer 26

collapsed lung, mediastinal shift, absent vascular markings

Question 27

whats tension pneumothorax?

Answer 27

deviated trachea and haemodynamic instability (perfusion failure)

requires immediate needle decompression (very satisfying!) - before drainage!

Question 28

Treatment of pneumothorax

Answer 28

a. observation b. aspiration c. drainage dependent on

• primary v secondary
• symptoms
• size
• risk of recurrence