Pneumothorax And Pleural Effusion Flashcards
What is pneumothorax?
Air within the pleural cavity. Disrupts the negative pressure of the pleural space and causes lung collapse
What causes tension pneumothorax?
Valve like properties of the interrupted pleural seal cause one way flow of air into the pleural cavity, resulting in compression of the lung and mediastinal shift, alongside tachycardia and hypoxia.
What is primary pneumothorax?
What are some risk factors?
Pneumothorax in those with no underlying lung pathology.
Male gender, family history of pneumothorax, smoking, young.
What are risk factors for secondary pneumothorax?
COPD, Asthma, Bronchiectasis, Lung cancer, Marfans syndrome/Ehlers danlos syndrome, Infections of lung eg TB
What is the main cause of a spontaneous pneumothorax?
Bursting of a subpleural blen/bullus.
What is an iatrogenic cause of pneumothorax?
Insertion of a central line or pacemaker, lung surgeries etc.
What is the most common type of pneumothorax?
Simple spontaneous primary pneumothorax.
How might simple pneumothorax present?
Sharp pleuritic chest pain with shortness of breath and history of trauma or lung disease.
Upon examination, what is found in simple pneumothorax?
Chest movement reduced on affected side,
Hyper resonance on percussion.
Reduced lung sounds,
Reduced vocal resonance.
What are the radiological findings in simple pneumothorax?
Lung hyperlucency,
Absent lung markings,
Collapsed lung borders.
What options are there for treatment of simple pneumothorax?
Pleural aspiration (max 2.5L drained),
Chest drain under ultrasound guidance,
Conservative management.
What are the borders of the safe triangle for chest drains?
Superior - base of axilla,
Inferior - 5th intercostal space,
Anterior - lateral edge of pectoralis major,
Posterior - lateral edge of latissimus dorsi muscle
What additional signs and symptoms are seen in tension pneumothorax?
Respiratory distress, Cyanosis, Tachycardia, Hypoxaemia, Deviated trachea.
How is tension pneumothorax treated?
Emergency needle decompression in the 2nd intercostal space mid clavicular line.
What is pleural effusion?
Excess fluid within the pleural cavity
What are the four types of pleural effusion?
Simple effusion - pleural fluid (transudate or exudate).
Haemothorax - blood.
Chylothorax - lymph.
Empyema - pus.
What signs and symptoms are seen in pleural effusion?
Reduced chest movement on affected side, Dull, stony percussion, Vesicular reduced breath sounds, Reduced vocal resonance, Shortness of breath, Pleuritic chest pain.
What findings are seen on imaging for pleural effusion?
Meniscal lines, white lower lobe opacifications.
What is the most common cause of haemothorax and chylothorax?
What about empyema?
Trauma.
Infection.
What further investigations can be done for pleural effusion?
Pleural aspiration (ultrasound guided). Test protein levels, glucose levels, LDH, pH and cultured for organisms.
What is the difference between transudate and exudate?
Transudate - <0.5 pleural serum protein, <0.6 pleural:serum LDH ratio.
Exudate - >0.5 pleural serum protein, >0.6 pleural:serum ratio.
Which conditions commonly cause transudate?
Congestive cardiac failure, nephrotic syndrome, liver cirrhosis, hypoproteinaemia.
Which conditions commonly cause exudate?
Infection (TB, pneumonia), lung malignancy, pulmonary infarction.
What treatments are available for pleural effusion?
Chest aspiration,
Indwelling pleural catheters and pleurodesis (obliteration of the pleural space) in those with recurrent effusion.
What X-ray features indicate a tension pneumothorax over a simple pneumothorax?
Marked lung expansion and hyperinflation,
Mediastinal shift away from affected side,
Tracheal deviation away from affected side.
