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Suprim Beshies 2020 > Pleural Effusion > Flashcards

Pleural Effusion Flashcards

1
Q

Causes of Exudative Pleural Effusion (4)

A
  1. Bacterial pneumonia
  2. Malignancy
  3. Viral Infection
  4. Pulmonary Embolism
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2
Q

Lights Criteria (3)

A

AT LEAST ONE

  1. PLEURAL fluid protein/ SERUM fluid >0.5
  2. PLEURAL fluid LDH/SERUM LDH >0.6
  3. Pleural Fluid LDH more than two-thirds normal upper limit for serum
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3
Q

Light’s Criteria misidentify transudates as exudates by how many %?

A

~25% are misidentified as exudates

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4
Q

Protein Gradient Value to Disregard Exudate based on Lights Criteria?

A

PROTEIN GRADIENT > 31 g/L (3.1g/dL) then EXUDATE is IGNORED! Because almost all patients with the above gradient have a TRANSUDATIVE effusion.

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5
Q

Additional Diagnostics in Exudative Effusions

A
  1. Description of the appearance
  2. Glucose Level
  3. Differential Cell count
  4. Microbiologic Studies
  5. Cytology
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6
Q

MOST COMMON CAUSE of Pleural effusion

A

Left Ventricular Failure

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7
Q

Indications for Thoracentesis in Patients with Heart Failure (3)

A
  1. Effusions are NOT BILATERAL and COMPARABLE in size
  2. Patient Febrile
  3. Pleuritic Chest pain
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8
Q

Pleural Pro-BNP level diagnostic of effusion from heart failure?

A

> 1500 pg/mL of Pleural fluid NT proBNP (N-terminal pro-brain natriuretic peptide) is virtually diagnostic of effusion from heart failure

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9
Q

Most Common Cause of Exudative Effusion in the United States

A

Parapneumonic Effusion

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10
Q

Common Causes of Parapneumonic Effusion? (3)`

A
  1. bacterial pneumonia
  2. lung abscess
  3. bronchiectasis
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11
Q

Minimum depth indicating a therapeutic thoracentesis?

A

> 10 mm

IF the free fluid separates the lung from the chest wall >10 mm a THERAPEUTIC thora should be performed

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12
Q

INDICATIONS for CTT/INVASIVE (increasing importance) (5)

A
  1. Loculated pleural fluid
  2. Pleural pH <7.20
  3. Pleural fluid glucose <3.3 mmol (<60 mg/dL)
  4. POSITIVE Gram stain OR Culture of fluid
  5. Gross Pus in the pleural space
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13
Q

Other considered interventions if empyema cannot be completely removed by thoracentesis?

A

CONSIDER chest tube insertion and instilling a FIBRINOLYTIC Agent OR Thoracoscopy
If ineffective, consider DECORTICATION

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14
Q

SECOND MOST COMMON of EXUDATIVE effusion

A

Malignant Pleural Effusion

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15
Q

Top three tumors causing ~75% of all malignant effusions:

A
  1. Lung Carcinoma
  2. Breast Carcinoma
  3. Lymphoma
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16
Q

In suspected Malignant Effusions with negative cytology what is the next best procedure?

A

Thoracoscopy.

ALTERNATIVE to Thoracoscopy
CT or UTZ guided biopsy of pleural thickening or nodules.

17
Q

Most Common Symptom of Pulmonary Embolism?

A

Dyspnea

18
Q

Characteristic of pleural effusion in Pulmo Embo?

A

Exudative (ALWAYS.)

19
Q

Most Common cause of Exudative Pleural Effusion

A

TB

20
Q

TB Markers in Pleural Fluid

A

Adenosine Deaminase >40 IU/L
Interferon Gamma >140 pg/mL

ALTERNATIVES
pleura fluid TB culture
needle biopsy of pleura
thoracoscopy

21
Q

Most common cause of chylothorax?

A

Trauma from thoracic surgery

22
Q

Pleural Fluid Triglyceride Level for Chylothorax?

A

Triglyceride >1.2 mmol/L (110mg/dL)

23
Q

Treatment of Choice in Chylothorax?

A 
Chest tube PLUS Octreotide
if they fail:
percutaneous transabdominal thoracic duct blockage
Alternatives:
ligation of thoracic duct
24
Q

Pleural Hematocrit for diagnosing hemothorax?

A

> 50% of peripheral blood = HEMOTHORAX

25
Q

Components of Meigs Syndrome (3)

A
  1. benign ovarian tumor
  2. ascites
  3. pleural effusion
    also can be due to ovarian hyperstimulation syndrome
26
Q

CABG associated Effusion seen WHEN? and Characteristic?

A

FIRST week = LEFT SIDED and BLOODY respond to 1 or 2 thera thoras
AFTER first few weeks = left sided, clear yellow, tend to recur

27
Q

Hemothorax Volume indicating thoracostomy?

A

> 200 ml/h

consider angiogaphic coil embolization, Thoracoscopy or thoracotomy

28
Q

Fibrinolytic Agents (2)

A
  1. Tissue plasminogen activator 10 mg

2. Deoxyribonuclease 5 mg

29
Q

DDx of Transudative Pleural Effusions (7)

A
  1. CHF
  2. Cirrhosis
  3. Nephrotic Syndrome
  4. Peritoneal Dialysis
  5. SVC obstruction
  6. Myxedema
  7. Urinothorax
30
Q

Medical Manipulations that Induce Pleural Effusions

A
  1. CABG
  2. abdominal Sx
  3. Radiation Therapy
  4. Liver, Lung or Heart Transplantation
  5. Intravascular insertion of central lines
31
Q

Reasons for Hemothorax (2)

A
  1. Trauma

2. rupture of a blood vessel or tumor

32
Q

Initial recommended treatment for Primary Spontaneous Pneumothorax? Alternatives If not responsive?

A

Simple aspiration

If not responsive or recurrent: thoracoscopy with stapling of blebs and pleural abrasion (almost 100% in preventing reccurrences)

33
Q

Management of Iatrogenic Traumatic Pneumothorax (3)

A
  1. Supplemental Oxygen
  2. Aspiration
  3. Tube thoracostomy
34
Q

Describe Chest tube placement in Hemopneumothorax

A

One chest tube in the superior part of hemithorax to evacuate air
ANOTHER chest tube placed inferior part of the hemithorax to remove the blood

35
Q

Initial Treatment or Maneuver for Tension Pneumothorax

A

Large bore needle into pleural space through the second anterior intercostal space

36
Q

PE findings in Tension Pneumothorax (3)

A
  1. Enlarged hemithorax with no breath sounds
  2. Hyperresonance to percussion
  3. Shift of mediastinum to contralateral side
37
Q

Signs strongly suggesting Tension Pneumothorax (2)

A
  1. Difficulty in ventilation during resuscitation

2. High Peak Inspiratory pressures during mechanical ventilation

Suprim Beshies 2020 (4 decks)

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