Pleural malignancy Flashcards
What does the visceral pleura cover and what does it form?
The lungs and it forms the interloper fissures
What does the parietal pleura cover?
The mediastinum, diaphragm and inner surface of the thorax
Do the hila have pleural coverage?
No as the two layers combine around the hill of the lung
What do the pleural layers combine to form?
The pulmonary ligament which runs inferiorly and attached the root of the lung to the diaphragm.
What is a pleural effusion?
An abnormal collection of fluid in the pleural space
What two types of pleural effusions can you get?
Transudates - fluid has < 30g of protein
Exudates - fluid has > 30g of protein
What investigations should you do in a pleural effusion?
History and examination
PA CXR
Biochemistry - transudate or exudate
Cytology - looking for malignant cells, lymphocytes etc
When would a pleural effusion not require drainage or sampling?
In cardiac failure
What would straw-coloured pleural fluid indicate?
Cardiac failure, hypoalbuminaemia
What would bloody pleural fluid indicate?
Trauma, malignancy, infection, infarction.
What would turbid/milky pleural fluid indicate?
Empyema, chylothorax
What would foul smelling pleural fluid indicate?
Anaerobic empyema
What would food particles in the pleural fluid indicate?
Oesophageal rupture
What might bilateral pleural effusion indicate?
LVF, PTE, Drugs, systemic path
What is a chylothroax?
A chylothorax (or chyle leak) is a type of pleural effusion. It results from lymph formed in the digestive system called chyle accumulating in the pleural cavity due to either disruption or obstruction of the thoracic duct.
What might a transudate pleural effusion indicate?
Heart failure, liver cirrhosis, hypoalbuminaemia, Peritoneal dialysis, Atelectasis (ITU or post surgery)
Doesn’t always have benign aetiology - 1 in 10 are serious, not to worry too much
What might an exudate pleural effusion indicate?
Malignany, infection inc TB, PE, Bacterial pneumonia
Always look for serious pathology
describe fluid pH in pleural effusions?
Normal is around 7.6
< 7.3 suggests pleural inflammation (malignancy or Rh A)
< 7.2 then it requires drainage in the setting of infection
Describe glucose in a pleural effusion?
LOW in infection, Tb, RhA, malignant, SLE etc
What might some symptoms of a pleural effusion be?
Asymtomatic
Dyspnea
Pleuritic chest pain
What might be some signs of a pleural effusion?
Decreased expansion
Stony dull percussion
Diminished great sounds over affected area
Vocal resonance are decreased
Might be trachael deviation in severe cases
What is a mesothelioma?
Uncommon malignant tumour of the lining of the lung or very occasionally of the lining of the abdominal cavity.
Linked with exposure to asbestos
Often takes 30–40 years to develop.
What might some symptoms of mesothelioma be?
May cause breathlessness, chest pain, weight loss, fever, sweating and cough.
What investigations would you do for mesothelioma?
Imaging
PLerual flid aspiration
Biospy
