Pleural Pathologies

Question 1

Transudative pleural effusion

Answer 1

Occurs d/t increased hydrostatic pressure or low plasma oncotic pressure

Question 2

Exudative pleural effusion

Answer 2

High protein, occurs d/t inflammation and increases capillary permeability

Question 3

Pleural effusion pearls

Answer 3

• Increased amylase: pancreatitis, malignancy
• Milky opalescent fluid: chylothorax
• Frank purulent fluid: empyema
• Bloody effusion: malignancy
• Exudative effusions prim. lympocytic: TB
• pH <7.2: parapneumonic effusions of empyema
• Glucose <60: RA

Question 4

Empyema etiology

Answer 4

untreated exudative pleural effusion

Question 5

Empyema clinical manifestation

Answer 5

• pus within pleural space

- MC: pneumonia

Question 6

Empyema Dx finding

Answer 6

• Frank purulent fluid

- pH <7.2

Question 7

Empyema management

Answer 7

• Drainage of pleura w/ antibiotic tx

Question 8

Chylothorax etiology

Answer 8

• Damage to thoracic duct collection within the pleural cavity

Question 9

Chylothorax MCC

Answer 9

• Lymphomas

- Trauma (2nd most common-surgical trauma to thoracic duct)

Question 10

Chylothorax dx finding

Answer 10

• Milky opalescent fluid

- Triglycerides >110 mg/dl

Question 11

Pleurisy etiology

Answer 11

• inflammation, viral infection (MC), Bornholm disease

- mimics an MI- get hx

Question 12

Pleurisy tx

Answer 12

• Treat underlying etiology
• NSAIDs for pain
• Indomethacin 50mg PO TID

Question 13

Simple/Spontaneous pneumothorax

Answer 13

• MC: tall, lean young men 25-30 yr old, smoker

- 2nd MC/complicated: COPD, more life-threatening

Question 14

Simple/Spontaneous pneumothorax dx finding

Answer 14

• Mediastinal shift toward the side of the thorax

- Healthy lung is pushing damaged lung away from it

Question 15

Open pneumothorax

Answer 15

Sucking chest wound- air going in and out is heard

Question 16

Open pneumothorax management

Answer 16

Immediately cover the entry wound w/ three side occlusive dressing

Question 17

Tension pneumothorax

Answer 17

• Shifts the mediastinum and trachea away from the side of pneumothorax
• Accumulation of air within the pleural space

Question 18

Tension pneumothorax management

Answer 18

Chest needle decompression with large bore needle 2/3rd intercostal space in midclavicular line above the rib

Question 19

Hemothorax

Answer 19

Blood accumulation in pleural cavity

Question 20

Hemothorax management

Answer 20

Tube thoracostomy

Question 21

Flail chest/pulmonary contusion

Answer 21

• Injury/trauma to the chest
• Fail: 2+ ribs broken in 2+ places
• Reduce tidal volume
• MCC: MVA