Pleural Diseases - Slocum

Question 1

_ effusions occur secondary to increased pulm capillary wedge presure or decreased oncotic pressure

Answer 1

Transudative effusion. Intact capillaries lead to protein poor pleural fluid

Question 2

_ effusion occur secondary to increased vascular permeability

Answer 2

Exudative. Inflammation leads to leaky capillaries, resulting in a protein rich pleural fluid

Question 3

what are common causes of transudative

Answer 3

CHF
nephrotic syndrome
cirrhosis
protein losing enteropahty
SLE or RA

Question 4

Common causes of exudative pleural effusion

Answer 4

• malignancy
• TB
• Bacterial/viral infection
• Empyema
• PE with infarct
• RA
• SLE
• Pancreatitis
• pericarditis
• Post-MI
• Pneumonia
• Trauma

Question 5

Sp gr <1.016
Protein <3 g/dl
Pleural/serum protein

Answer 5

Transudative

Question 6

Sp gr >1.016
Protein >3 g/dl
Pleural/serum protein >0.5
Pleural/seurm LDH >0.6
indicates what kind of pleural effusion

Answer 6

Exudative pleural effusion

Question 7

Signs and symptoms of Pleural effusion

Answer 7

• often asymptomatic
• may present with dyspnea
• pleuritic chest pain
• respirophasic chest pain
• cough
• dullness to percussion
• decreased breath sounds over effusion
• decreased tactile fremitus

Question 8

CXR findings of pleural effusion

Answer 8

blunting of costophrenic anges

decubitus CXR will identify free-flowing versus loculated fluid collections

Question 9

What is the diagnostic gold standard for pleural effusion

Answer 9

Thoracentesis: indicated for new effusion >1cm in decubitus view; send pleral fluid for CBC, proien, LDH, pH, glucose, gram stain; send for cytology if neoplasm suspected

Question 10

Treatment for Pleural effusion

Answer 10

• Transudative: tx underlying cause as first line
• Malignant pleural effusion: chemo/radiation; asymptomatic do not need tx. Symptomatic: thoracentesis; pleuodesis for malignant effusion that do not respond to chemo/radiation

Parapneumonic pleural effusion: uncomplicated; resolves on it’s own. if empyema then drain; Complicated parapneu effusion - tube thoracostomy when glucose >60 or pH 7.2, chest tube indicated for empyema.

Question 11

what are the differnt types of pneumothorax

Answer 11

1. Primary = no lung disease, could be due to rupture of subpleural apical blebs (tall, thin males)
2. secondary = complication of preexisting pulm disease
3. Traumatic = penetrating or blunt trauma
4. Iatrogenic = following medical intervention
5. Tension = penetrating trauma, injection, CPR, mechanical ventilation

Question 12

Signs and symptoms of pneumothorax

Answer 12

• sudden-onset, unilateral, pleuritic chest pain
• dyspnea
• acute resp distress
• decreased or absent breath sounds
• hyperresonance on percussion
• tracheal deviation
• decreased or absent tactile fremitus

Question 13

What is the gold standard for diagnosis of pneumothorax

Answer 13

• CXR. best obeserved in upright, end expiration films.
  will show collapsed lungs
  may show broken ribs o other trauma

Question 14

How are large and/or tension pneumothorax treated?

Answer 14

• immediate needle decompression
• Chest tube following decompression
• pleurodesis: injection of irritant into pleural space helps scar the two pleural layers together prevent recurrence and pleural effusion