Pneumothorax and Pleural Effusion

Question 1

What is pneumothorax?

Answer 1

The presence of air in the pleural space

Question 2

What age and gender does primary spontaneous pneumothorax most commonly occur in?

Answer 2

Young tall thin males (usually caused by rupture of pleural bleb/bulla)

Question 3

What does a secondary pneumothorax usually occur secondary to?

Answer 3

Underlying lung disease eg asthma, COPD
or
Trauma eg rib fracture
or 
High pressure ventilation

Question 4

What is a tension pneumothorax?

Answer 4

Pneumothorax causing mediastinal shift an cardiovascular collapse - occurs when air enters the pleural space but cannot escape because of a flap that closes on expiration (like a one way valve) - this is why there is mediastinal shift

Question 5

What are some signs of tension pneumothorax?

Answer 5

Reduced breath sounds, hyperresonance, hypotension, tracheal deviation

Question 6

Why is hypotension seen in a tension pneumothorax?

Answer 6

Compromised venous return to heart as IVC is compressed

Question 7

How is a tension pneumothorax treated?

Answer 7

Insertion of a plastic cannula into the second intercostal space in the mid clavicular line

Question 8

Where is a chest drain placed for pneumothorax?

Answer 8

5th intercostal space mid axillary line

Question 9

True or False:

A chest drain should be removed during inspiration

Answer 9

False

Should be removed at the end of expiration

(this is because there is an increase in negative pressure in the pleural space during inspiration which would suck air back in)

Question 10

Why is fluid more likely to accumulate in the pleural cavity than the peritoneal cavity?

Answer 10

Due to the negative pressure in pleura

Question 11

How is pleural fluid secreted and drained?

Answer 11

Secreted by parietal pleura, drained by lymphatics

Question 12

What is a pleural effusion?

Answer 12

Build up of fluid in the pleural space

Question 13

What is the difference between a transudate and an exudate?

Answer 13

Transudate - low protein

Exudate - high protein

Question 14

What are the common causes of a transudate pleural effusion?

Answer 14

Congestive heart failure
Liver failure (cirrhosis)
Nephrotic syndrome

Question 15

How come congestive heart failure can lead to a transudate pleural effusion?

Answer 15

Increased pleural capillary hydrostatic pressure (increased pressure in venous end of capillary, harder for fluid to move back in, failure in absorption)

Question 16

Why can cirrhosis and nephrotic syndrome lead to a transudate pleural effusion?

Answer 16

Decreased capillary oncotic pressure - low serum albumin levels - failure of absorption

Question 17

What kind of pleural effusion will congestive heart failure lead to?

Answer 17

Transudate

Question 18

What kind of pleural effusion will cirrhosis lead to?

Answer 18

Transudate

Question 19

What kind of pleural effusion will nephrotic syndrome lead to?

Answer 19

Transudate

Question 20

Describe the appearance of a transudate

Answer 20

Clear (not cloudy)

Question 21

Describe the appearance of an exudate

Answer 21

Cloudy

Question 22

What are exudate pleural effusions caused by?

Answer 22

Increased capillary permeability - seen in inflammation, malignancy

Question 23

What are some causes of exudate pleural effusions?

Answer 23

Infection, cancer, pulmonary infarction due to PE

Question 24

In general terms, do you think that bilateral pleural effusions are more likely to be due to exudates or transudates?

Answer 24

Transudates - more systemic causes

more likely to have an infection on one side, not both

Question 25

What will be heard on percussion of a pleural effusion?

Answer 25

Dullness