Pleural Effusion Flashcards
Most common cause of pleural effusion. (Harrison’s 19th edition, pp 1716)
Left ventricular failure
Occurs when local factors that influence the formation and absorption of pleural fluid are altered. (Harrison’s 19th edition, pp 1716)
Exudative pleural effusion
The leading cause of Transudative pleural effusion. (Harrison’s 19th edition, pp 1716)
Left ventricular failure
Most common cause of exudative pleural effusion. (Harrison’s 19th edition, pp 1717)
Parapneumonic effusions
Refers to a grossly purulent effusion. (Harrison’s 19th edition, pp 1717)
Emphyema
Occurs when systemic factors that influence the formation and absorption of pleural fluid are altered. (Harrison’s 19th edition, pp 1716)
Transudative pleural effusion
Second most common type of exudative pleural effusion. (Harrison’s 19th edition, pp 1717)
Effusion secondary to malignancy
Three tumors that cause ~75% of all malignant pleural effusion. (Harrison’s 19th edition, pp 1717)
Lung carcinoma
Breast carcinoma
Lymphoma
Lights criteria. (Harrison’s 19th edition, pp 1716)
Pleural fluid protein/serum protein > 0.5
Pleural fluid LDH/serum LDH > 0.6
Pleural fluid LDH more than two-thirds the normal upper limit for the serum
*Exudative pleural effusions meet at least one
Most important indication for chest tube insertion. (Harrison’s 19th edition, pp 1717)
Presence of gross pus in the pleural space
Indication for Chest tube insertion. (Harrison’s 19th edition, pp 1717)
Loculated pleural fluid
Pleural fluid pH < 7.2
Pleural fluid glucose < 3.3mmol/L (<60mg/dL)
Positive gram stain or culture of the pleural fluid
Presence of gross pus in the pleural space
Diagnosis of TB pleuritis. (Harrison’s 19th edition, pp 1718)
High levels of TB markers in pleural fluid
(adenosine deaminase > 40IU/L or interferon y > 140 pg/mL
Most common cause of hemathoraxes. (Harrison’s 19th edition, pp 1718)
Trauma
Most patients with hemothorax should be treated with? (Harrison’s 19th edition, pp 1718)
Tube thoracostomy
Amount of pleural hemorrhage in considering to do thoracospy or thoracotomy. (Harrison’s 19th edition, pp 1718)
> 200mL/hr
Most common cause of chylothorax. (Harrison’s 19th edition, pp 1718)
Trauma
Most frequently thoracic surgery
Diagnostic criteria for hemothorax by using the hematocrit. (Harrison’s 19th edition, pp 1718)
If the PF Hct > ½ of the serum Hct
The diagnosis most commonly overlooked in the differential diagnosis of a patient with an undiagnosed pleural effusion. (Harrison’s 19th edition, pp 1717)
Pulmonary embolism
Diagnosis of malignant pleural effusion. (Harrison’s 19th edition, pp 1717)
Pleural fluid cytology
The next best procedure for the diagnosis of malignant pleural effusion if cytology examination is negative and malignancy is strongly suspected. (Harrison’s 19th edition, pp 1717)
Thoracoscopy
Transudative pleural effusion. (Harrison’s 19th edition, pp 1718)
superior vena cava Obstruction Nephrotic syndrome Myxedema CHF Cirrhosis Urinothorax Peritoneal dialysis (ON My Clear CUP)
The likely diagnosis if pleural fluid amylase level is elevated. (Harrison’s 19th edition, pp 1718)
Esophageal rupture
Pancreatic disease
Condition that should be considered if the patient is febrile, has predominantly polymorphonuclear cells in the pleural fluid, and has no pulmonary parenchymal abnormalities. (Harrison’s 19th edition, pp 1718)
Intraabdominal abscess
Triad of Benign ovarian tumors, Ascites and pleural effusion. (Harrison’s 19th edition, pp 1718)
Meigs’ syndrome
Medical manipulations that can induce pleural effusions. (Harrison’s 19th edition, pp 1718)
Coronary artery bypass surgery Abdominal surgery Radiation therapy Liver transplant Lung transplant Heart transplant Intravascular insertion of central lines
Characteristic of pleural effusion caused by Coronary Artery Bypass Surgery. (Harrison’s 19th edition, pp 1718)
Within the 1st week – Typically left-sided and bloody, with large numbers of eosinophils and respond to 1 or 2 therapeutic thoracentesis
After the 1st few weeks – Left sided and clear yellow, with predominantly small lymphocytes, and tend to recur
Cause of TB pleuritis. (Harrison’s 19th edition, pp 1718)
Hypersensitivity reaction to tuberculous protein in the pleural space
Predominant cells in TB pleuritis. (Harrison’s 19th edition, pp 1718)
Small lymphocytes
Clinical manifestation of TB pleuritis. (Harrison’s 19th edition, pp 1718)
Fever
Weight loss
Dyspnea
Pleuritic chest pain
Alternative diagnostic modality to establish the diagnosis of TB pleuritis aside from high levels of TB markers in the pleural fluid. (Harrison’s 19th edition, pp 1718)
Culture of the pleural fluid
Needle biopsy of the pleura
Thoracoscopy
Recommended treatment for TB Pleuritis. (Harrison’s 19th edition, pp 1718)
Identical with PTB
Occurs when there is an excess quantity of fluid in the pleural space. (Harrison’s 19th edition, pp 1716)
Pleural effusion
Accumulation of pleural fluid happens when there is? (Harrison’s 19th edition, pp 1716)
Pleural fluid formation exceeds pleural fluid absorption
Entry of fluid to the pleural space. (Harrison’s 19th edition, pp 1716)
Capillaries in the parietal pleura
From the interstitial spaces of the lung via the visceral pleura
From the peritoneal cavity via small holes in the diaphragm
Exit of fluid from the pleural space. (Harrison’s 19th edition, pp 1716)
Lymphatics in the parietal pleura
Capacity of the lymphatics to absorb fluid. (Harrison’s 19th edition, pp 1716)
20 times more than is formed
Diagnostic modality of choice for Pleural effusion. (Harrison’s 19th edition, pp 1716)
Chest ultrasound
Leading causes of transudative pleural effusions. (Harrison’s 19th edition, pp 1716)
LV failure
Cirrhosis
Leading causes of exudative pleural effusions. (Harrison’s 19th edition, pp 1716)
Bacterial pneumonia
Malignancy
Viral infection
Pulmonary embolism
Tests that should be obtained if a patient has an exudative pleural effusion. (Harrison’s 19th edition, pp 1716)
Description of the appearance of the fluid Glucose level Differential cell count Microbiologic studies Cytology
Computation that should be obtained if a patient is clinically thought to have a condition producing a transudative effusion but have met one or more exudative criteria. (Harrison’s 19th edition, pp 1718)
Serum-pleural fluid protein gradient
Lights criteria can be ignored if gradient is > 31g/L (3.1g/dL) because almost all patients have a transudative pleural effusion
Indication to do diagnostic thoracentesis in patients with heart failure. (Harrison’s 19th edition, pp 1717)
If effusion is not bilateral and comparable in size
Febrile
(+) Pleuritic chest pain
Diagnostic blood exam for effusion secondary to congestive heart failure. (Harrison’s 19th edition, pp 1717)
N-terminal pro-brain natriuretic peptide (NT-proBNP) > 1500pg/mL
Occurs when the thoracic duct is disrupted and chyle accumulates in the pleural space. (Harrison’s 19th edition, pp 1718)
Chylothorax
Presentation of patients with chylothorax. (Harrison’s 19th edition, pp 1718)
Dyspnea
Large effusion on CXR
Milky fluid on thoracentesis
In chylothorax, triglyceride level in the pleural fluid. (Harrison’s 19th edition, pp 1718)
> 1.2mmol/L (110mg/dL)
Diagnostics of choice on patients with chylothorax and no obvious trauma. (Harrison’s 19th edition, pp 1718)
Lymphangiogram
Mediastinal CT scan
Treatment of choice for chylothorax. (Harrison’s 19th edition, pp 1718)
Insertion of chest tube + administration of ocreotide
If fails, Pleuroperitoneal shunt (unless patient has chylous ascites)
Alternative treatment for chylothorax. (Harrison’s 19th edition, pp 1718)
Ligation of the thoracic duct
Percutaneous transabdominal thoracic duct blockage
Patients with chylothoraxes should not undergo prolonged tube thoracostomy with chest tube drainage because this will lead to? (Harrison’s 19th edition, pp 1718)
Malnutrition
Immunologic incompetence
Occurrence of pleural effusion in patients with cirrhosis and ascites. (Harrison’s 19th edition, pp 1717)
~5%
Predominant mechanism of hepatic hydrothorax. (Harrison’s 19th edition, pp 1717)
Direct movement of peritoneal fluid through small openings in the diaphragm into the pleural space
Characteristics of hepatic hydrothorax. (Harrison’s 19th edition, pp 1717)
Usually right sided
Frequently large enough to produce severe dyspnea
Associated diseases for parapneumonic effusion. (Harrison’s 19th edition, pp 1717)
Bacterial pneumonia
Lung abscess
Bronchiectasis
Presentation of patients with pleural effusion secondary to aerobic bacterial pneumonia. (Harrison’s 19th edition, pp 1717)
Acute febrile illness
Chest pain
Sputum production
Leukocytosis
Presentation of patients with pleural effusion secondary to anaerobic bacterial pneumonia. (Harrison’s 19th edition, pp 1717)
Subacute illness Weight loss Brisk leukocytosis Mild anemia Predisposing factors to aspiration
Diagnostic modalities that can demonstrate presence of free pleural fluid. (Harrison’s 19th edition, pp 1717)
Lateral decubitus radiograph
Computed tomography (CT) of the chest
Ultrasound
Therapeutic thoracentesis should be performed if the free fluid separates the lung from the chest wall by? (Harrison’s 19th edition, pp 1717)
> 10mm
Most common symptom of patients with pleural effusion secondary to pulmonary embolism. (Harrison’s 19th edition, pp 1717)
Dyspnea
Possible outcomes/complications for pleural effusions secondary to pulmonary embolism that increases in size after anticoagulation. (Harrison’s 19th edition, pp 1717)
Recurrent emboli
Hemothorax
Pleural infection
Primary tumors that arise from the mesothelial cells that line the pleural cavities. (Harrison’s 19th edition, pp 1717)
Malignant mesotheliomas
The usual diagnostic modality for diagnosing Mesothelioma. (Harrison’s 19th edition, pp 1717)
Image-guided needle biopsy
Thoracoscopy
Most common risk factor for developing mesothelioma. (Harrison’s 19th edition, pp 1717)
Asbestos exposure
Chest radiograph findings in Mesothelioma. (Harrison’s 19th edition, pp 1717)
Pleural effusion
Generalized pleural thickening
Shrunken hemothorax
Presentation of patients with mesothelioma. (Harrison’s 19th edition, pp 1717)
Chest pain
Shortness of breath
In malignant pleural effusion, this procedure should be done to induce pleurodesis. (Harrison’s 19th edition, pp 1717)
Pleural abrasion
Alternative diagnostic modality for malignant pleural effusion. (Harrison’s 19th edition, pp 1717)
CT/UTZ guided needle biopsy of pleural thickening or nodules
Treatment for malignant pleural effusion. (Harrison’s 19th edition, pp 1717)
Therapeutic thoracentesis
If symptoms are relieved, may do the ff:
1) Insertion of a small indwelling catheter.
2) tube thoracostomy with the instillation of a sclerosing agent (doxycycline 500mg)
Treatment for parapneumonic pleural effusion. (Harrison’s 19th edition, pp 1717)
Initial and repeat thoracentesis
if fluid not completely removed, may do the ff:
1) Chest tube insertion + combination of fibrinolytic agent (10mg Tissue plasminogen activator) and Deoxyribonuclease (5mg) instillation
2) Thoracoscopy with breakdown of adhesions
if ineffective, do decortication
Differential diagnosis if pleural fluid glucose level is < 60mg/dL. (Harrison’s 19th edition, pp 1717)
Malignancy
Bacterial infections
Rheumatoid pleuritis
