pleural disorders Flashcards
procedure used to obtain a sample of fluid from the space around the lungs via needle insertion; used as diagnostic tool in new pleural effusion (except if CHF) and therapeutically
thoracentesis
- pleural effusion that forms in the pleural space adjacent to a pneumonia
Parapneumonic effusion (PPE)
4 C/I to thoracentesis
- coagulopathy (INR > 2, plts < 25k)
- severe lung dz on opposite side
- mechanical ventilation PEPP
- site of insertion has known bullous dz
meniscus sign is indicative of?
pleural effusion
what should you always do after thoracentesis
get a CXR
poorly treated PPE develops a fibrinous reaction of the pleura leading to what?
loculated effusion
- Fluid is trapped w/in the fissures, or btwn pleural layers when they are partly fused.
- occur most typically with exudative pleural effusions, particularly parapneumonic effusions or hemothorax
- typically needs surgical procedure to fix
loculated effusions
most common complication of thoracentesis
pneumothorax
5 other thoracentesis complications
- re-expansion pulmonary edema (don’t take off more than 1L)
- hemothorax
- infection
- hypotension
- hepatic or splenic puncture
5 other thoracentesis complications
- re-expansion pulmonary edema (don’t take off more than 1L)
- hemothorax
- infection
- hypotension
- hepatic or splenic puncture
what should you also order to r/o chylothorax
triglyceride levels
Light criteria says its exudative if 1 of these 3 are present
- pleural protein/serum protein over 0.5
- pleural fluid LDH/serum LDH over 0.6
- plerual LDH > 2/3 the upper limit of normal serum LDH
If none of these apply then it is transudate
what kind of effusion occurs when systemic factors cause either increased hydrostatic presusre or decreased oncotic pressure
transudate vs exudate
transudate
WBC < 1000
what kind of effusion occurs when systemic factors cause either increased hydrostatic presusre or decreased oncotic pressure
transudate vs exudate
transudate
WBC < 1000
what kind of effusion occurs when there is increased capillary permeability d/t infection or inflammation
transudate vs exudate
exudate
WBC > 1000
CHF, nephrotic syndrome, cirrhosis, pulm. edema, ascities, hypoalbuminemia, malnutrition
these are all etiologies of what kind of pleural effusion
etiologies of transudative effusion
TB, cancer, pneumonia, pancreatitis, pulmonary infarction, systemic LE
these are etiologies of what kind of pleural effusion
exudative
CLASSICAL MANAGEMENT OF TENSION PNEUMOTHORAX
decompression with needle thoracostomy
patients will need a chest tube after
where is needle inserted with thoracostomy
- 2nd rib space at mid clavicular line
what kind of pneumothorax
pleural cavity pressure < atm pressure
closed PTX
what kind of pneumothorax
pleural cavity pressure = atm. pressure
open PTX
what kind of pneumothorax
pleural cavity pressure greater than atm pressure
tension PTX
compare P.E. of pleural effusion w/ PTX what do they both have? what is different?
- BOTH: decreased breath sounds & fremitus
- percussion: effusion has dullness vs PTX has hyperresonance
- no known lung dz; rupture of apical subpleural blebs d/t shear force
- mostly affects tall young men
primary vs secondary PTX?
Primary
has underlying lung dz like asthma or COPD
primary or secondary PTX?
secondary
tx for PTX if small + asymp. vs symp + mod-large
- small & no sx: observation
- sx and bigger: chest tube
any type of pneumothorax where positive air pressure pushes trachea, great vessels or heart to opposite side; air is trapped during expiration
TENSION PTX
on CXR, decreased peripheral markings extending into the periphery is indicative of
PTX
PE of tension PTX
- increased JVP
- systemic hypotension
- pulsus paradoxus
what do you call this: visceral pleural line running parallel w/ ribs
also what is is it associated with?
companion lines
associated w/ pneumothorax
