Pleural Disorders Flashcards
What is serous fluid produced by?
The parietal pleura produces it, the visceral layer absorbs it.
Pleuritis
AKA Pleurisy
A localized inflammation of pleural surfaces that produces sharp localized pain.
Pleuritis Clinical presentation
Localized, pleuritic chest pain
Coughing, pleural rub
Pleural rub (fine crackles)
Ipsilateral shoulder pain
Causes of pleuritis
Viral infxn
Thoracic trauma
Secondary to pulmonary disorders
Secondary to system (autoimmune) dz
What does a CXR generally show in pleuritis?
Nothing. normal. finit.
Pleuritis Tx
Treat primary cause
Symptomatic treatment
Analgesics
Pleural Effusion
Results when fluid collects btw parietal and visceral pleural layers
Occurs when normal flow of fluid is disrupted
PLeural effusion presentation
SOB, cough
Pleuritic CP
Causes of pleural effusion (most common on top)
CHF Pneumonia Malignancy PE VIral CABG surgery
Which CXR should be obtained for an effusion?
PA and lateral decubitus (laying down)
Blunting of a constophrenic angle is indicative of how much fluid?
250 - 500ml
Thoracocentesis
Fine needle aspiraiton of pleural fluid for diagnostic purposes
Transudative vs. exudative effusion
Transudative is clear and odorless generally from CHF, leaky capillaries.
Exudative is generally from infective process or neoplasm.
Light’s Criteria for pleural effusion
Pleural/serum protein ratio >.5
Pleural/serum LDH ratio >.6
Pleural fluid LDH > 200
Parapneumonic Effusion
Pleural effusions that occur in the pleural space adjacent to a bacterial pneumonia
Typically small
If bacteria invade pleural space, empyema may result.
Malignant pleural effusion
Cancer causes the effusion
Usually lung or breast cancer
May be bloody
What must pleural fluid Hct be to diagnose hemothorax
50%
Pleurodesis
Fusion of the parietal and visceral pleura to prevent recurrent pneumothorax or effusions.
Can be chemical (causes inflammation and fusion) or mechanical
Hemothorax
Hemorrhagic pleural effusion
Results from blood accumulation in pleural cavity
Usually caused by trauma
Can also occur atraumatically from disease process
Atelectasis
Incomplete expansion of the lung which leads to collapse of the alveoli.
Collapses lung
May lead to small pleural effusions
Atelectasis presentation
Pain Cough, dyspnea Dullness to percussion DIminished resonance Friction rub
Pneumothorax (Ptx)
Collection of air in the pleural space
Intrapleural pressure may meet or exceed atmP and cause lung collapse.
Primary spontaneous Ptx
A disease of young males
Tall, slim body habitus
Cigarette smoking
May cause parenchymal blebs
Secondary Ptx
Due to underlying pulmonary dz
COPD, asthma, cystic fibrosis
Traumatic Ptx
Parenchymal injury vs.
Tracheobronchial vs.
Esophageal injury
The Open Ptx
Sucking chest wound
Occlusive dressing
Thoracostomy away from wound
Asbestosis
Slowly progressive pulmonary fibrosis
Wide spectrum pleural involvement on CXR
No specific tx
Mesothelioma
Insidious neoplasm arising from mesothelial surfaces of the pleurae
70% of cases due to asbestos exposure
Palpable chest wall mass
Lymphangioleiomyomatosis (LAM)
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
