Pleural Effusion Flashcards
Excess quantity of fluid in the pleural space which should normally contain a very thin layer of fluid
Pleural effusion
Etiology of pleural effusion
Pleural fluid formation > pleural fluid absorption
*Decreased lymphatic drainage
Due to alteration of SYSTEMIC factors that influence formation and absorption of pleural fluid
Transudative
Due to alteration of LOCAL factors that influence the formation and absorption of pleural fluid
Exudative
Leading causes of transudative effusion
LV failure: MC
cirrhosis
Leading causes of exudative effusion
Bacterial pneumonia
Malignancy
Viral Infection
Pulmonary Embolism
Light Criteria (exudative effusions)
PF/serum protein >0.5
PF/serum LDH >0.6
PF LDH >2/3 upper normal serum limit
At least one
Considerations for increased amylase
Esophageal rupture
Pancreatic pleural effusion
Malignancy
Considerations for glucose <60 mg/dL
Malignancy
Bacterial Infections
Rheumatoid pleuritis
Diagnostic modality if no diagnosis and no improvement of symptoms
Thoracoscopy or Open pleural biopsy
Serum-PF gradient likely to be transudative
> 31 g/L
Indications for diagnostic thoracentesis in effusion due to heart failure
Unilateral or unequal effusion, (+) fever, (+) pleuritic chest pain
Measurement if effusion persists despite therapy
Pleural fluid proBNP
> 1500 diagnostic of CHF
Mechanism of hepatic hydrothorax
Direct movement of peritonea fluid through small holes in the diaphragm into the pleural space
MC exudative pleural effusion
Parapneumonic
Factors indicating need for tube thoracostomy
Presence of gross pus in the pleural space
Positive gram stain or culture of the pleural fluid
Pleural fluid glucose <60mg/dl
Pleural fluid pH <7.20
Loculated pleural fluid
2nd MC type of exudative pleural effusion
Malignant pleural effusions from metastatic disease
3 tumors that cause malignant pleural effusions
Lung
Breast
Lymphoma
Mineral associated with malignant mesotheliomas
Asbestos
MCC of exudative effusion
Tuberculous pleuritis
TB markers in pleural fluid of tuberculous pericarditis
Adenosine deaminase >40 IU/L
Gamma interferon >140 pg/ml
MCC of chylothorax
Trauma
Pleural fluid diagnostic of chylothroax
Milky, Triglyceride level >110 mg/dl
Treatment for chylothorax
CTT + octreotide
MCC of hemothorax
Trauma
Diagnostic of hemothorax
Bloody, PF hematocrit >50% of peripheral blood hematocrit
Treatment of hemothorax
CTT
Meig’s syndome
Pleural effusion + Ascites + Benign ovarian tumors
Presence of gas in the pleural space
Pneumothorax
Positive pressure in pleural space throughout the respiratory cycle
Tension pneumothorax
Mechanism of primary spontaneous pneumothorax
Rupture of apical blebs
*almost exclusively in smokers
Treatment of primary spontaneous pneumothorax
Simple aspiration
*or stapling of blebs
MCC of secondary spontaneous pneumothorax
COPD
Treatment of secondary spontaneous pneumothorax
tube thoracostomy
thoracoscopy
thoracotomy with stapling of blebs and pleural abrasion
Treatment of hemopneumothorax
One chest tube in the superior part of the hemithorax to evacuate the air, another tube in the inferior part of the hemithorax to remove the blood
MCC of tension pneumothorax
Mechanical ventilation
Resuscitation
Intervention in tension pneumothorax
Large-bore needle inserted into the pleural space theough the second anterior ICS then thoracostomy tube inserted before removing needle
