Pleural Disorders

Question 1

What is serous fluid produced by?

Answer 1

The parietal pleura produces it, the visceral layer absorbs it.

Question 2

Pleuritis

Answer 2

AKA Pleurisy

A localized inflammation of pleural surfaces that produces sharp localized pain.

Question 3

Pleuritis Clinical presentation

Answer 3

Localized, pleuritic chest pain
Coughing, pleural rub
Pleural rub (fine crackles)
Ipsilateral shoulder pain

Question 4

Causes of pleuritis

Answer 4

Viral infxn
Thoracic trauma
Secondary to pulmonary disorders
Secondary to system (autoimmune) dz

Question 5

What does a CXR generally show in pleuritis?

Answer 5

Nothing. normal. finit.

Question 6

Pleuritis Tx

Answer 6

Treat primary cause
Symptomatic treatment
Analgesics

Question 7

Pleural Effusion

Answer 7

Results when fluid collects btw parietal and visceral pleural layers
Occurs when normal flow of fluid is disrupted

Question 8

PLeural effusion presentation

Answer 8

SOB, cough

Pleuritic CP

Question 9

Causes of pleural effusion (most common on top)

Answer 9

CHF
Pneumonia
Malignancy
PE
VIral
CABG surgery

Question 10

Which CXR should be obtained for an effusion?

Answer 10

PA and lateral decubitus (laying down)

Question 11

Blunting of a constophrenic angle is indicative of how much fluid?

Answer 11

250 - 500ml

Question 12

Thoracocentesis

Answer 12

Fine needle aspiraiton of pleural fluid for diagnostic purposes

Question 13

Transudative vs. exudative effusion

Answer 13

Transudative is clear and odorless generally from CHF, leaky capillaries.
Exudative is generally from infective process or neoplasm.

Question 14

Light’s Criteria for pleural effusion

Answer 14

Pleural/serum protein ratio >.5
Pleural/serum LDH ratio >.6
Pleural fluid LDH > 200

Question 15

Parapneumonic Effusion

Answer 15

Pleural effusions that occur in the pleural space adjacent to a bacterial pneumonia
Typically small
If bacteria invade pleural space, empyema may result.

Question 16

Malignant pleural effusion

Answer 16

Cancer causes the effusion
Usually lung or breast cancer
May be bloody

Question 17

What must pleural fluid Hct be to diagnose hemothorax

Answer 17

50%

Question 18

Pleurodesis

Answer 18

Fusion of the parietal and visceral pleura to prevent recurrent pneumothorax or effusions.
Can be chemical (causes inflammation and fusion) or mechanical

Question 19

Hemothorax

Answer 19

Hemorrhagic pleural effusion
Results from blood accumulation in pleural cavity
Usually caused by trauma
Can also occur atraumatically from disease process

Question 20

Atelectasis

Answer 20

Incomplete expansion of the lung which leads to collapse of the alveoli.
Collapses lung
May lead to small pleural effusions

Question 21

Atelectasis presentation

Answer 21

Pain
Cough, dyspnea
Dullness to percussion
DIminished resonance
Friction rub

Question 22

Pneumothorax (Ptx)

Answer 22

Collection of air in the pleural space

Intrapleural pressure may meet or exceed atmP and cause lung collapse.

Question 23

Primary spontaneous Ptx

Answer 23

A disease of young males
Tall, slim body habitus
Cigarette smoking
May cause parenchymal blebs

Question 24

Secondary Ptx

Answer 24

Due to underlying pulmonary dz

COPD, asthma, cystic fibrosis

Question 25

Traumatic Ptx

Answer 25

Parenchymal injury vs. Tracheobronchial vs. Esophageal injury

Question 26

The Open Ptx

Answer 26

Sucking chest wound Occlusive dressing Thoracostomy away from wound

Question 27

Asbestosis

Answer 27

Slowly progressive pulmonary fibrosis Wide spectrum pleural involvement on CXR No specific tx

Question 28

Mesothelioma

Answer 28

Insidious neoplasm arising from mesothelial surfaces of the pleurae 70% of cases due to asbestos exposure Palpable chest wall mass

Question 29

Lymphangioleiomyomatosis (LAM)

Answer 29

``` Rare dz of women of child bearing age Affects small vessels and microvasculature Dz of smooth-muscle like cells Causes chylous effusions Tx with anti-estrogen therapy ```