Pleural Disorders Flashcards
What produces the pleural fluid?
parietal pleura
Key characteristics of pleuritic chest pain
increased with deep inspiration and may be associated with pleural rub
Clinical features of pleural effusion
SOB, cough, pleuritic chest pain
What are the top three most common causes of pleural effusion?
CHF, pneumonia, malignancy
What is the Lights Criteria for exudative effusion?
Pleural Protein : Serum Protein > 0.5. Pleural LDH : Serum LDH > 0.6. Pleural LDH > 200
What causes exudative pleural effusion?
Anything that causes inflammatory or infiltrative disease of the pleura (neoplasm, infection)
What causes transudative pleural effusion?
Anything that causes increased hydrostatic pressure or decreased capillary colloid osmotic pressure (CHF, hypoalbuminemia, cirrhosis)
Define parapneumonic effusion
Pleural effusions that occur in the pleural space adjacent to a bacterial pneumonia
In what percent of patients does a bloody pleural effusion without a history of trauma or pulmonary infarction indicate a neoplasm?
90%
T/F atelectasis usually leads to small pleural effusions not requiring intervention
true
Physcial exam findings of atelectasis
dullness to percussion, diminished vocal resonance, dimished tactile vocal fremitus, friction rub
Define atelectasis
incomplete expansion of the lung which leads to collapse of the alveoli
What is the etiology of primary spontaneous pneumothorax?
parenchymal blebs- small air-filled lesions just under the pleural surface.
What is the etiology of secondary pneumothorax?
underlying pulmonary disease (COPD/Asthma/CF)
How should you treat an open pneumothorax (sucking-chest wound)?
thoracostomy away from the traumatic wound
Describe clinical management of asbestosis
CXR and PFTs every 3 to 5 years. Supplemental oxygen when there is resting hypoxemia. Pneumococcal and influenza vaccination
Common physical findings of mesothelioma
Unilateral dullness to percussion at the lung base, Palpable chest wall masses, scoliosis towards the side of the malignancy
T/F Most cases of mesothelioma will show bilateral pleural abnormality with a large, bilateral pleural effusion
False. Most cases of mesothelioma will show UNILATERAL pleural abnormality with a large, UNILATERAL pleural effusion
What will you see on CXR of a young women of reproductive age who has lymphagioleiomyomatosis (LAM)?
hyperinflated lungs and a chylous effusion
What is the treatment for LAM?
antiestrogen therapy (medroxyprogesterone, tamoxifen) or transplantation
