Pleural diseases: effusion + pneumothorax Flashcards
whats the pleura?
serous membrane that folds back on itself to form a 2-layered membranous pleural sac. Visceral and parietal
topography of the pleura?
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
functions of the pleura?
- Pleura allows movement of lung against chest wall
- Coupling system between lungs and chest wall – elastic recoil and max neg pressure
- Clearing fluid from the pulmonary interstitium
what does pleural fluid contain?
protein (mainly albumin, globulin and fibrinogen), few cells mainly mesothelial cells, monocytes and lymphocytes
what are the causes of pleural plaques?
benign + asbestos related
whats a pneumothorax?
abnormal collection of air within cavity
whats pleural effusion?
fluid in pleural space due to malfunction in production/absorption of fluid
transudate
relatively low protein states
exudates
higher protein concentration
empyema
pus in pleural space
chylothorax
chyle in pleural space (lymph with fat)
what are transudate effusions caused by?
increased venous pressure or hypoproteinaemia
what are exudate effusions caused by?
increased leakiness of pleural capillaries secondary to infection, inflammation or malignancy
causes: pneumonia, tb, pulm infarction, RA, SLE
Presentation of pleural effusion
decreased expansion, stony dull percussion note, diminished breath sounds on the affected side
tracheal deviation away from large effusions
pleuritic chest pain
What would you look for in CXR for pleural effusion?
mass/mets?
consolidation?
completely flat horizontal upper border –> there is also a pneumothorax
Use of ultrasound for pleural effusion?
to identify presence of pleural fluid + guide aspiration
Whats thoracentesis?
also called pleural tap: removing air/fluid from the pleural space
biochem, appearance, transudate vs exudate
if pleural protein is more than half of the serum protein, what is it?
an exudate
or if pleural LDH:serumLDH > 0.6
if pleural fluid is straw coloured instead of clear, what is it?
an exudate
Tx for pleural effusion
drainage
surgery: if persistent collections and increasing pleural thickness
is marfrans syndrome a cause of primary or secondary spontaneous pneumothorax?
primary! (PSP)
list 2 secondary causes of spontaneous pneumothorax
COPD, pulmonary fibrosis
what does catamenial mean?
associated with menstruation
signs of pneumothorax
reduced expansion
hyper-resonance to percussion
diminished breath sounds on affected side
symptoms of pneumothorax
may be asymptomatic
or sudden onset of dyspnea and/or pleuritic chest pain
CXR penumothorax
collapsed lung, mediastinal shift, absent vascular markings
whats tension pneumothorax?
deviated trachea and haemodynamic instability (perfusion failure)
requires immediate needle decompression (very satisfying!) - before drainage!
Treatment of pneumothorax
a. observation b. aspiration c. drainage dependent on
- primary v secondary
- symptoms
- size
- risk of recurrence