Pleural Effusion - Serofibrinous/Serosanguineous pleurisy Flashcards
Define serofibrinous pleurisy
Pleural surface: fibrinous exudate
Pleural cavity: exudative effusion of serous fluid
Serofibrinous pleurisy is generally associated with what conditions (2)
Lung infections
Inflammatory conditions of abdomen or mediastinum
Occasionally, Serofibrinous pleurisy is found in what conditions?
CT diseases -lupus erythematosus -periarteritis -RA Primary/Metastatic neoplasms of lung, pleura, or mediastinum
This condition is commonly associated with hemorrhagic pleurisy
Tumors
The rate of fluid formation is dictated by what law?
Starling’s Law
The rate of fluid formation is dictated by Starling’s Law. What determines the movement of fluid? (2)
1 - Hydrostatic pressure and osmotic pressure BALANCE in pleural space and pulmonary capillary bed
2 - PERMEABILITY of pleural membrane
Normal level of fluid present in pleural space
10 mL
Pathology of Serofibrinous/ serosanguineous pleurisy with pleural effusion
Fluid formation exceeds clearance leading to accumulation –> inflammation –> increase pleural space permeability with increase proteinaceous fluid formation –> obstruction of lymphatic absorption
Large fluid collections will produce what s/sx(m (6)
Cough Dyspnea Retractions Tachypnea Orthopnea Cyanosis
PE findings on percussion
Dullness to flatness
Breath sounds are decrease of absent
PE findings on palpation
Diminution on tactile fremitus
PE findings on inspection
Shift of mediastinum AWAY/OPPOSITE from the affected side
Fullness of ICS
If extensive pneumonia is present, what audible findings will you find
Crackles
Rhonchi
This finding is usually detected only during EARLY or LATE plastic stage
Friction rubs
In infants, this is heard instead of decreased breath sounds
Bronchial breathing
Radiographic exam result will show
Homegeneous density obliterating normal markings of lungs
In radiographs, small effusions is seen to cause
Obliterations of ostophrenic or cardiophrenic angles or
Widening of interlobar septa
Radiographic exam should be performed in what 2 positions; to demonstrate shift of effusion with change in position, this position is helpful.
Supine and upright
Decubitus position
If effusion is loculated, this useful tool may guide thoracentesis
UTZ
Essential to differentiate exudate from transudate
Exam of fluid
Often present in blood chem?
Hypoalbuminemia
Give at least 1 feature of an EXUDATE (5)
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
In malignancy, rheumatoid disease and TB, the glucose level is usually
<60 mg/dL
These findings suggest TB (2)
Many small lymphocytes
pH <7.20
Fluid of Serofibrinous pleurisy
Clear or slightly cloudy
Few leukocytes
Occasionally, some erythrocytes
DDx
Empyema
Hydrothorax
Hemothorax
Hydrothorax
Tx if effusion is large >10mm on xray
Drainage / Thoracentesis
Rapid removal of >|= 1L may be associated with development of what condition?
Reexpansion pulmonary edema
If fluid reaccumulates causing respi embarassment, what should be performed?
Chest tube drainage
Tube thoracostomy is considered necessary in older children if (3)
Suspected with parapneumonic effusion
Pleural fluid pH is <7.20
PL glucose <50 mg/dL
Indication for tube drainage with fibrinolytic therapy or less often Video-assisted thoracoscopic surgery (VATS)
Fluid is thick loculated clearly purulent
Px may need this after thoracentesis or chest tube insertion
Analgesia
Px with acute pneumonia may need (2)
Antibiotic tx
Supplemental O2
This drugs may be beneficial in addition to antibiotics and drainage in pxs with parapneumonic effusions
Dexamethasone
