Pleural Effusion - Serofibrinous/Serosanguineous pleurisy

Question 1

Define serofibrinous pleurisy

Answer 1

Pleural surface: fibrinous exudate

Pleural cavity: exudative effusion of serous fluid

Question 2

Serofibrinous pleurisy is generally associated with what conditions (2)

Answer 2

Lung infections

Inflammatory conditions of abdomen or mediastinum

Question 3

Occasionally, Serofibrinous pleurisy is found in what conditions?

Answer 3

CT diseases
-lupus erythematosus
-periarteritis
-RA
Primary/Metastatic neoplasms of lung, pleura, or mediastinum

Question 4

This condition is commonly associated with hemorrhagic pleurisy

Answer 4

Tumors

Question 5

The rate of fluid formation is dictated by what law?

Answer 5

Starling’s Law

Question 6

The rate of fluid formation is dictated by Starling’s Law. What determines the movement of fluid? (2)

Answer 6

1 - Hydrostatic pressure and osmotic pressure BALANCE in pleural space and pulmonary capillary bed

2 - PERMEABILITY of pleural membrane

Question 7

Normal level of fluid present in pleural space

Answer 7

10 mL

Question 8

Pathology of Serofibrinous/ serosanguineous pleurisy with pleural effusion

Answer 8

Fluid formation exceeds clearance leading to accumulation –> inflammation –> increase pleural space permeability with increase proteinaceous fluid formation –> obstruction of lymphatic absorption

Question 9

Large fluid collections will produce what s/sx(m (6)

Answer 9

Cough
Dyspnea
Retractions
Tachypnea
Orthopnea
Cyanosis

Question 10

PE findings on percussion

Answer 10

Dullness to flatness

Breath sounds are decrease of absent

Question 11

PE findings on palpation

Answer 11

Diminution on tactile fremitus

Question 12

PE findings on inspection

Answer 12

Shift of mediastinum AWAY/OPPOSITE from the affected side

Fullness of ICS

Question 13

If extensive pneumonia is present, what audible findings will you find

Answer 13

Crackles

Rhonchi

Question 14

This finding is usually detected only during EARLY or LATE plastic stage

Answer 14

Friction rubs

Question 15

In infants, this is heard instead of decreased breath sounds

Answer 15

Bronchial breathing

Question 16

Radiographic exam result will show

Answer 16

Homegeneous density obliterating normal markings of lungs

Question 17

In radiographs, small effusions is seen to cause

Answer 17

Obliterations of ostophrenic or cardiophrenic angles or

Widening of interlobar septa

Question 18

Radiographic exam should be performed in what 2 positions; to demonstrate shift of effusion with change in position, this position is helpful.

Answer 18

Supine and upright

Decubitus position

Question 19

If effusion is loculated, this useful tool may guide thoracentesis

Answer 19

UTZ

Question 20

Essential to differentiate exudate from transudate

Answer 20

Exam of fluid

Question 21

Often present in blood chem?

Answer 21

Hypoalbuminemia

Question 22

Give at least 1 feature of an EXUDATE (5)

Answer 22

1 - protein level of >3.0 g/dL
2 - pleural fluid:serum protein ratio >0.5
3 - PF LDH >200 IU/L
4 - fluid:serum LDH ratio >0.6
5 - pH <7.20

Question 23

In malignancy, rheumatoid disease and TB, the glucose level is usually

Answer 23

<60 mg/dL

Question 24

These findings suggest TB (2)

Answer 24

Many small lymphocytes

pH <7.20

Question 25

Fluid of Serofibrinous pleurisy

Answer 25

Clear or slightly cloudy
Few leukocytes
Occasionally, some erythrocytes

Question 26

DDx

Answer 26

Empyema
Hydrothorax
Hemothorax
Hydrothorax

Question 27

Tx if effusion is large >10mm on xray

Answer 27

Drainage / Thoracentesis

Question 28

Rapid removal of >|= 1L may be associated with development of what condition?

Answer 28

Reexpansion pulmonary edema

Question 29

If fluid reaccumulates causing respi embarassment, what should be performed?

Answer 29

Chest tube drainage

Question 30

Tube thoracostomy is considered necessary in older children if (3)

Answer 30

Suspected with parapneumonic effusion
Pleural fluid pH is <7.20
PL glucose <50 mg/dL

Question 31

Indication for tube drainage with fibrinolytic therapy or less often Video-assisted thoracoscopic surgery (VATS)

Answer 31

Fluid is thick loculated clearly purulent

Question 32

Px may need this after thoracentesis or chest tube insertion

Answer 32

Analgesia

Question 33

Px with acute pneumonia may need (2)

Answer 33

Antibiotic tx

Supplemental O2

Question 34

This drugs may be beneficial in addition to antibiotics and drainage in pxs with parapneumonic effusions

Answer 34

Dexamethasone