Pleural Malignancy

Question 1

What does the visceral pleura cover?

Answer 1

The lungs

Forms the interlobar fissures

Question 2

What does the parietal pleura cover?

Answer 2

The mediastinum, diaphragm, and inner surface of the thorax

Question 3

What volume of fluid is needed in the pleura for it to be detected on CXR?

Answer 3

200ml

Question 4

Pleural Effusion

Answer 4

Abnormal collection of fluid in pleural space

Question 5

What can straw-coloured pleural fluid indicate?

Answer 5

Cardiac failure

Hypoalbuminaemia

Question 6

What can bloody pleural fluid indicate?

Answer 6

Trauma
Malignancy
Infection
Infarction

Question 7

What can white/milky pleural fluid indicate?

Answer 7

Empyema

Chylothorax

Question 8

What can foul smelling pleural fluid indicate?

Answer 8

Anaerobic empyema

Question 9

What can food particles/amylase in pleural fluid indicate

Answer 9

Oesophageal rupture

Question 10

What can bilateral pleural fluid indicate?

Answer 10

LVF
PTE
Drugs
Systemic path

Question 11

Transudate

Answer 11

Protein <30g/L
Heart failure, Liver cirrhosis, Hypoalbuminaemia, Atelectasis (ITU or post surgery), Peritoneal dialysis. Hypoproteinaemia
Not always benign

Question 12

Exudate

Answer 12

Protein > 30 g/L
Malignancy, Infection inc TB, Pulmonary infarct, asbestos, connective tissue disease
Always look for serious pathology

Question 13

What is normal fluid pH?

Answer 13

7.6

Question 14

What does ph <7.3 suggest?

Answer 14

Pleural inflammation (malignancy, Rh A)

Question 15

What does pH <7.2 require?

Answer 15

Drainage

Question 16

What does low glucose indicate?

Answer 16

Infection, TB,Rheumatoid arthritis, malignancy, oesophageal rupture, SLE

Question 17

Systemic tumour effects of ancillary effusion

Answer 17

Embolism

Hypoalbuminaemia

Question 18

Local tumour effects of ancillary effusion

Answer 18

Postobstructive infection
Lymphatic obstruction
Atelectasis

Question 19

Mesothelioma

Answer 19

Uncommon malignant tumour of the lining of the lung or very occasionally of the lining of the abdominal cavity

Question 20

LENT score for predicting survival in MPE

Answer 20

Lactate DeHydrogenase (LDH)
ECOG Performance Status
Neutrophil to lymphocyte ratio (serum)
Tumour type

Question 21

Primary pneumothorax

Answer 21

Occurs without a precipitating event in the absence of clinical lung disease
Normal lungs in which apical bullae rupture

Question 22

Secondary pneumothorax

Answer 22

Pneumothorax that occurs as a complication of underlying lung disease

Question 23

Presentation of pneumothorac

Answer 23

Acute onset pleuritic chest pain
SOB, hypoxia
Tachycardia
Hyper-resonant percussion note
Reduced expansion
Quiet breath sounds on auscultation
Hamman's sign

Question 24

Tension pneumothorax

Answer 24

One-way valve, progressively increasing pressure in pleural space
Pushes other chest organs to opposite side from affected side

Question 25

Signs of tension pneumothorax

Answer 25

Trachea deviated to opposite side
Hypotension
Raised JVP
Reduced air entry on affected side