Pleural & Mediastinal Disease Flashcards
Comparing pleural fluid and serum levels of _____ and _____ is used to distinguish transudative from exudative pleural effusions
LDH; protein
In which type of effusion is there more protein and LDH in the pleural fluid?
Exudative
if ANY of the following it is exudative:
Pleural protein:Serum protein >0.5
Pleural LDH:Serum LDH >0.6
Pleural fluid LDH >2/3 upper limits of serum LDH in the lab doing the measurement
In what type of effusion is there less protein and LDH in the pleural fluid as compared to the serum, as well as lower leukocyte count and pH between 7.45-7.55?
Transudate
Type of effusion caused by unbalanced hydrostatic forces and more commonly associated with heart failure and cirrhosis and less commonly nephrosis and constrictive pericarditis
Transudate
Type of effusion usually caused by inflammatory, infectious, and malignant conditions and less commonly by collagen vascular disease, intra-abdominal processes, and hypothyroidism
Exudate
Most common cause of transudate
Heart failure [usually left ventricular failure or CHF]
Note that diuresis can increase pleural fluid protein and LDH, resulting in discordant exudate
List causes of transudative effusion
Heart failure
Liver cirrhosis
Misplaced central line
Nephrotic syndrome
[others from reading included atelectasis, constrictive pericarditis, duropleural fistula, hypoalbuminemia, peritoneal dialysis, SVC obstruction, trapped lung, and urinothorax]
Small transudative effusion caused by increased negative intrapleural pressure; common in ICU patients
Atelectasis
Cause of bilateral transudative effusions in which heart size is normal, but JVD is present in 95% of cases
Constrictive pericarditis
Cause of transudative effusion in which there is CSF in the pleural space, caused by trauma or surgery
Duropleural fistula
List some causes of exudative pleural effusion
Malignancy
Pleuritis (often due to SLE or other collagen vascular diseases)
Venous thromboembolic disease (particularly in the case of pulmonary infarct)
Tuberculosis
Pneumonia or other infectious process
Condition in which pressure of air in pleural space exceeds ambient pressure throughout respiratory cycle; as air pressure builds, affected lung is compressed and all mediastinal tissues are displaced to the opposite side of the chest
Tension pneumothorax
What causes primary/spontaneous pneumothorax?
Rupture of subpleural blebs in response to high negative intrapleural pressure
Common management strategy for pneumothorax consisting of indwelling catheter in pleural space allowing for at-home drainage
PleurX catheter
Management strategy for pneumothorax that closes potential space between parietal and visceral pleura, utilizes talc, tetracycline, etc. through thorascope or in IR
Pleurodesis
