Pleural Malignancy Flashcards
What amount of liquid is normally found in the lungs?
4mls
How much XS liquid is needed in the lungs to be detected in a CXR?
200ml
what allows the pleura to slide smoothly during respiration?
serous fluid
what creates a seal between the lung surface and the thoracic wall?
surface tension
why do the hila of the lungs have no pleural coverage?
the 2 layers (lung surface and thoracic wall) combine around the hila of the lung
d: pleural effusion
Abnormal collection of fluid in pleural space
what is the term for draining the liquid?
pleural aspiration
if the liquid comes out straw coloured, what diseases could it be?
cardiac failure
hypoalbuminaemia
if the liquid comes out bloody, what diseases could it be?
trauma
malignancy
infection
infarction
if the liquid comes out turbid/milky, what diseases could it be?
empyema
chylothorax
if the liquid comes out foul smelling, what diseases could it be?
anaerobic empyema
if the liquid comes out with food particles, what diseases could it be?
oesophageal rupture
if the liquid comes out bilateral, what diseases could it be?
left ventricle failure
pulmonary thromboembolism
drugs
systemic path
d: transudates + colour
clear
protein <30g/L
caused by a rise in pressure or low protein level of the blood vessels
d: exudates + colour
cloudy
protein >30g/L
effusions result from leakages in the blood vessels due to inflammation of the pleura
name some diseases producing transudates in effusion
Heart failure Liver cirrhosis Hypoalbuminaemia Atelectasis (ITU or post surgery) Peritoneal dialysis
name some diseases producing exudates in effusion
Malignancy
Infection inc TB
Pulmonary infarct
Asbestos
What is the normal fluid pH for effusion?
7.6
what does a pH of <7.3 suggest?
pleural inflammation malignancy
what does a pH of <7.2 require?
drainage in setting of infection
is glucose in fluid high/low in infection?
low
if lymphocytes were found in the fluid what would that suggest?
TB
malignancy
if neutrophils were found in the fluid what would that suggest?
it was an acute process
d: pleural tap
the removal of fluid from the area between the chest cavity and the tissue lining of the lungs
medical name for a pleural tap?
thoracentesis
name 2 ancillary effusions that are systemic tumour effects
embolism
hypoalbuminaemia
name ancillary effusions that are local tumour effects
postobstructive infection,
lymphatic obstruction,
atelectasis
d:atelectasis
collapse/closer of a lung
why is a CT guided needle better than a thoracoscopy for a pleural biopsy?
can see where you are going
what is a mesothelioma and where is it found?
Uncommon malignant tumour of the lining of the lung or very occasionally of the lining of the abdominal cavity
what is a particular cause of mesothelioma?
asbestos
d: sclerotherapy
is a procedure used to treat blood vessels or blood vessel malformations
what is a good sclerosing agent?
TALC
what may someone who has chronic pleural effusion get put in?
a pleural catheter
what is a long term pleural catheter?
Vacuum in drainage bottle that provides suction to drain pleural fluid
what is the max fluid a pleural catheter can drain a day?
1L
d: pneumothorax
collapsed lung due to air leaking into pleural space
symptoms of pneumothorax
Acute onset pleuritic chest pain SOB, hypoxia Signs Tachycardia Hyper-resonant percussion note Reduced expansion Quiet breath sounds on auscultation Hamman’s sign (‘Click’ on auscultation left side)
what is a small pneumothorax?
<2cm of air
what lever is pneumothorax air measured at?
hilar not apex
treatments of pneumothorax
Oxygen even if no drain Aspiration 1st line in PSP Chest drain May need suction (air leak >48 hours) Surgical intervention
what is a tension pneumothorax?
when a one-way valve is formed by an area of damaged tissue,
EMERGENCY
what happens in a tension pneumothorax?
One-way valve, progressively increasing pressure in pleural space
Pushes other chest organs to opposite side to affected side
Acute respiratory distress
signs of tension pneumothorax
Trachea deviated to opposite side
Hypotension
Raised JVP
Reduced air entry on affected side
causes of tension pneumothorax
Ventilated patient (invasive or not) Trauma CPR esp PEA Blocked, kinked, misplaced drain Pre existing airways disease Patients undergoing hyperbaric treatment
treatment of tension pneumothorax
Needle decompression
Usually with large bore venflon
Second intercostal space anteriorly, mid-clavicular line
Hisssssssssssss……..
name some risk factors for pleural infection
diabetes mellitus immunosuppression including corticosteroids gastro-oesophageal reflux alcohol misuse intravenous drug abuse
d: parapneumonic effusion
parapneumonic effusion is a type of pleural effusion that arises as a result of a pneumonia, lung abscess, or bronchiectasis
d: empyema
collection of pus in the pleural cavity cause by microorganisms
how do you treat pleural infection?
Antibiotics (often for several weeks) Drain effusion as needed Early discussion with surgeons if persistent sepsis Nutrition VTE prophylaxis ?role for fibrinolytics/Dnase Reassess patients who do not improve
