Pleural Malignancy Flashcards
What does the visceral pleura cover?
The lungs
Forms the interlobar fissures
What does the parietal pleura cover?
The mediastinum, diaphragm, and inner surface of the thorax
What volume of fluid is needed in the pleura for it to be detected on CXR?
200ml
Pleural Effusion
Abnormal collection of fluid in pleural space
What can straw-coloured pleural fluid indicate?
Cardiac failure
Hypoalbuminaemia
What can bloody pleural fluid indicate?
Trauma
Malignancy
Infection
Infarction
What can white/milky pleural fluid indicate?
Empyema
Chylothorax
What can foul smelling pleural fluid indicate?
Anaerobic empyema
What can food particles/amylase in pleural fluid indicate
Oesophageal rupture
What can bilateral pleural fluid indicate?
LVF
PTE
Drugs
Systemic path
Transudate
Protein <30g/L
Heart failure, Liver cirrhosis, Hypoalbuminaemia, Atelectasis (ITU or post surgery), Peritoneal dialysis. Hypoproteinaemia
Not always benign
Exudate
Protein > 30 g/L
Malignancy, Infection inc TB, Pulmonary infarct, asbestos, connective tissue disease
Always look for serious pathology
What is normal fluid pH?
7.6
What does ph <7.3 suggest?
Pleural inflammation (malignancy, Rh A)
What does pH <7.2 require?
Drainage
What does low glucose indicate?
Infection, TB,Rheumatoid arthritis, malignancy, oesophageal rupture, SLE
Systemic tumour effects of ancillary effusion
Embolism
Hypoalbuminaemia
Local tumour effects of ancillary effusion
Postobstructive infection
Lymphatic obstruction
Atelectasis
Mesothelioma
Uncommon malignant tumour of the lining of the lung or very occasionally of the lining of the abdominal cavity
LENT score for predicting survival in MPE
Lactate DeHydrogenase (LDH)
ECOG Performance Status
Neutrophil to lymphocyte ratio (serum)
Tumour type
Primary pneumothorax
Occurs without a precipitating event in the absence of clinical lung disease
Normal lungs in which apical bullae rupture
Secondary pneumothorax
Pneumothorax that occurs as a complication of underlying lung disease
Presentation of pneumothorac
Acute onset pleuritic chest pain SOB, hypoxia Tachycardia Hyper-resonant percussion note Reduced expansion Quiet breath sounds on auscultation Hamman's sign
Tension pneumothorax
One-way valve, progressively increasing pressure in pleural space
Pushes other chest organs to opposite side from affected side
Signs of tension pneumothorax
Trachea deviated to opposite side
Hypotension
Raised JVP
Reduced air entry on affected side
