Pleurisy, Pleural Effusions, and Empyema Flashcards
What is pleurisy
Inflammation of the pleura
MC cause of pleural effusion in children
Bacterial pneumonia
Most common causes of pleural effusion in children second to bacterial pneumonia
1) Heart failure 2) Rheumatologic 3) Metastatic intrathoracic malignancy
Inflammatory processes in the pleura are divided into 3
1) Dry or plastic 2) Serofibrinous or serosanguinous 3) Purulent pleurisy or empyema
Etiologies of dry/plastic pleurisy
1) Bacterial or viral pulmonary infection 2) Acute URTI 3) Tb 4) Connective tissue disease (e.g. RF)
Principal symptom of dry/plastic pleurisy
Pain
In dry/plastic pleurisy, the child often lies on which side relative to the affected side
ON the affected side in an attempt to decrease respiratory excursions
A leathery, rough, inspiratory and expiratory friction rub may be heard in which phase of illness in cases of dry/plastic pleurisy
Early or late
T/F Patients with pleurisy and pneumonia should always be screened for Tb
T
T/F In pneumonia with pleural effusion, immobilization of the chest and cough suppressive drugs are indicated
F
T/F In pleural effusion without pneumonia, strapping of the chest to restrict expansion may afford relief
T
Which type of pleurisy is associated with inflammatory conditions of the abdomen or mediastinum
Serofibrinous/serosanguinous
Type of pleurisy associated with primary or metastatic neoplasms of the lung, pleura, or mediastinum
Serofibrinous/serosanguinous
Hemorrhagic pleurisy are usually associated with what condition
Tumors
Pleural fluid usually come from
Capillaries of the parietal pleura
Pleural fluid is absorbed by what structures
Pleural stomas and lymphatics of the parietal pleura
The rate of pleural fluid formation is dictated by what law
Starling Law
Normally, only ___mL fluid is present in the pleural space
4-12
Mechanism of pleural effusion formation in pleural inflammation
1) Increased pleural membrane permeability 2) Increase proteinaceous fluid formation 2) Lymphatic absorption obstruction
Serofibrinous pleurisy is often preceded by
Plastic pleurisy
PE finding particularly in infants with pleurisy
Bronchial breathing
Exudate: Protein level
> 3 g/dL
Exudate: Pleural fluid:Serum protein ratio
> 0.5
Exudate: Pleural fluid LDH
Less than 200 IU/L
Exudate: Pleural fluid: Serum LDH ratio
> 0.6
Exudate: pH
Less than 7.2
Pleural fluid glucose level in malignancy, rheumatoid disease, and Tb
Less than 60 mg/dL
Pleural fluid exam finding of many small lymphocytes and pH less than 7.2 suggests what
Tuberculosis
SG of pleural fluid if it is a hydrothorax
Less than 1.015
Cells seen in pleural fluid in cases of hydrothorax
Mesothelial cells
Order of resolution of pleural effusion from quickest
Bacterial pneumonia > Tb, CT disease > Neoplasm
T/F When diagnostic thoracentesis is performed, as much fluid as possible should be removed for therapeutic purposes
T
Rapid removal of >1L of pleural fluid may be associated with the development of
Reexpansion pulmonary edema
Management for significant reaccumulation of pleural fluid after thoracentesis
Chest tube drainage
CTT is indicated in suspected parapneumonic pleural effusion given what characteristics if the pleural fluid
1) pH less than 7.2 2) Pleural fluid glucose less than 50 mg/dL
Thrombolytic therapy in cases of pleural effusion is indicated when
Pleural fluid is clearly purulent
Purulent pleurisy (empyema) is most often associated with what etiology
S. pneumoniae pneumonia
MC cause of empyema in developing nations, Asia, and posttraumatic empyema
S. aureus
Empyema is most frequently encountered in what age group
1) Infants 2) Preschool children
Stage of empyema wherein fibrinous exudate forms on the pleural surfaces
Exudative stage
Stage of empyema wherein fibrinous septa form causing loculation of fluid and thickening of parietal pleura
Fibrinopurulent stage
Stage of empyema wherein there is fibroblast proliferation
Organizational stage
Stage of empyema wherein there is formation of thick-walled cavities
Organizational stage
Condition in which pus dissects through the chest wall
Empyema necessitatis
T/F Thoracentesis should always be performed whenever empyema is suspected
T
of neutrophils that would point to a possible empyema
> 100,000/uL
T/F Blood cultures have a higher yield than cultures of pleural fluid
T
Bronchopleural fistulas and pyopneumothorax commonly develops in what type of pneumonia
Staphylococcal
This procedure is indicated if fibrinolysis and VATS are ineffective in empyema
Open decortication
T/F Instillation of antibiotics into the pleural cavity improves results
F
