Respiratory: Pleural Disease Flashcards
What are the causes of pleural disease?
Exudate (local disease) (High protein). Local factors influence the accumulation or clearance of fluid. o Malignancy – Lung, breast, pleural. o Infection – Pneumonia, empyema, pleuritis, viral disease o Autoimmune – Rheumatoid, SLE o Vascular – PTE o Cardiac – Pericarditis, CABG o Respiratory – Haemothorax, Chylothorax o Abdominal – Subphrenic abscess
Transudate (systemic illness) (Low protein <30g). Imbalance between oncotic and hydrostatic pressures
o Cardiac – CCF, PTE
o Liver – Ascites, Cirrhosis
o Renal – Glomerulonephritis, Nephrotic syndrome
o Ovarian – Meigs syndrome
o Autoimmune – Sarcoid
o Thyroid – Myxoedema
What are the signs and symptoms of pleural disease?
Asymptomatic
Pleuritic pain – sharp on inspiration
SOB
What are the causes of empyema?
Pneumonia, bronchiectasis
Strep pneumonia
Staph
HI
Outline the pathophysiology of empyema?
Fluid in the pleural space can become infected = high fibrin content = fluid thickens and sticks together = pockets of pus = stops lung inflating = diff breathing
What are the signs and symptoms of empyema?
Fever, night sweats, SOB, sweating, weight loss, productive cough, lethargy, temp
How does empyema present on examination?
Stoney dull percussion
Reduced breath sounds
Reduced chest expansion
How should empyema be investigated?
Clinical - suspect in pts with pneumonia that don’t improve on treatment
X-ray, US, CT
Bloods = procalcitonin (raised), CRP, WBC
Aspiration
‣ PH = <7.25
‣ Colour = turbid, hazy, pus-like
How should empyema be managed?
IV Abx (poor tissue penetration) co-amoxiclav
+/- chest drain
Surgery if non-resolving - thoracotomy
High protein diet - poss NG tube
What are the complications of empyema?
Lung collapse
Fibrosis
Decreased lung function
Mortality = 20-30%
What are the causes of pleural effusion?
Failure to absorb ‣ Cirrhosis ‣ Nephrotic syndrome ‣ HF ‣ Lymphatic obstruction - Ca
Over production
‣ Infection
‣ Ca
‣ Pulmonary infarction due to PE
How does pleural effusion present on examination?
Stoney dull percussion
Reduced air entry
Reduced chest expansion
How is pleural effusion treated?
Chest drain
Ca treatment
Kidney disease management
What are the causes of a pneumothorax?
Primary – burst sub pleural bulla
Secondary (to underlying lung disease or trauma) ‣ COPD ‣ CF ‣ Asthma ‣ Fractured rib ‣ Sharp chest trauma
Iatrogenic – high pressure ventilation
‣ Aspiration
‣ High pressure ventilation
How does a pneumothorax present on examination?
More resonant percussion
Reduced breath sounds
Reduced chest expansion
How is a pneumothorax treated?
Tension = 2nd ICS mid-clavicular line
Pneumothorax = 5th ICS mid-axillary line
What are the risk factors for mesothelioma
Asbestos
FH
Radiation therapy to the chest
Outline the pathophysiology of mesothelioma
Begins as discrete plaques and nodules that coalesce to produce a sheetlike neoplasm
Tumour growth usually starts at the lower part of the chest
Tumour may invade the diaphragm and encase the surface of the lung and interlobar fissures
What are the signs and symptoms of mesothelioma?
Chest pain, painful cough, SOB, lumps of tissue under the skin on the chest, weight loss
How should mesothelioma be investigated?
CXR - lobar thickening from the edge of the lung
CT
Aspiration
Biopsy
MRI
PET
How is mesothelioma best managed?
Surgery to decrease fluid buildup, remove tissue around lungs, remove a lung
Chemotherapy
Radiotherapy
Immunotherapy
What complications are associated with mesothelioma?
Pleural effusion
Pain caused by pressure on the nerves and the spine
