SM 172a - Pleural Diseases Flashcards
Which layer of pleura is thicker?
The visceral pleura is thicker than the parietal pleura
An exudative pleural effusion with low glucose on thoracentesis is most worrisome for…
- Infection
- Malignancy with metastasis to the pleura
- Rheumatoid arthritis
A cardiogenic pleural infusion is [transudative/exudative]
A cardiogenic pleural infusion is transudative
How is pleural effusion diagnosed?
Bedside ultrasound
Confirms findings of chest x-ray and can guide safe drainage
(Chest x-ray may miss a pleural effusion)
What is the treatment for a plerual effusion?
Drain if large and symptomatic or when infected
- If transudative
- Treat HF first, effusion will usually resolve on its own
- If exudative
- Additional testing is necessary
What is the treatment for pneumothorax?
- Small pneumothorax
- May go away on its own
- Large pneumothorax (tension)
- Emergent needle decompression
- Chest tube drainage
- May obliterate pleural space to prevent recurrence
A patient with a pleural effusion has the following labs:
Pleural fluid LDH = 200 units/L
Serum LDH = 200 units/L
Pleural fluid hematocrit = 30%
Serum hematocrit = 48%
What is the most likely cause of the pleural effusion?
This is an exudative pleural effusion
Pleural LDH / Serum LDH = 1
Pleural fluid hematocrit > 50% of serum hematocrit indicates a hemothorax
Most likely caused by trauma
An exudative pleural effusion with low pH on thoracentesis is most worrisome for…
- Infection
- Malignancy w/pleural metastasis
- Esophageal perforation
Must drain if pH < 7.2
A patient with a pleural effusion has the following labs:
Pleural fluid LDH = 200 units/L
Serum LDH = 200 units/L
Lymphocytes = 80%
What are the most likely causes of the pleural effusion?
This is an exudative pleural effusion
Pleural LDH / Serum LDH = 1
Lymphocyte-predominance increases the liklihood of:
- Autimmune disorder (ex: connective tissue diesease)
- Cancer/malignancy
- Tuberculosis
- If >5% mesothelial cells, it is not TB
- Fungal infection
How does parapneumonic effusion lead to plerual effusion?
A parapneumonic effusion is caused by inflammation
Inflammation -> increased permeabiltiy of capillaries and pleural lining, leading to fluid leakage into the pleural space
How can a pneumothorax lead to heart failure?
If the pneumothorax is closed, air will build up in the pleural space with every expiration
Intrapleural pressure becomes positive, and puts pressure on the right atirum
This impairs filling fo the heart, leading to circulatory collapse
Describe the presentation of a patient with a pleural effusion
Often asymptomatic and usually nonspecific if symptomatic
- Nonproductive cough
- Chest discomfort
- Pain indicates inflammation of the parietal pleura
- Dyspnea
What is an empyema?
Pus in the pleural space
What determines fluid flow in the pleural space?
Starling forces
A patient with a pleural effusion has the following labs:
Pleural fluid LDH = 200 units/L
Serum LDH = 200 units/L
Neutrophils = 80%
What is the most likely cause of the pleural effusion?
This is an exudative pleural effusion
Pleural LDH / Serum LDH = 1
Neutrophil-predominance increases the liklihood of infection (ex: bacterial pneumonia) as the cause of the pleural effusion
What is the function of pleural fluid?
Lubricates the pleural space, allowing for mechanical coupling of the lung, chest wall, and diaphragm
Where is microfilration pressure highest:
The parietal or visceral pleura?
The microfiltration pressure is higher in the parietal pleura - it drains into the systemic circulation
The visceral pleura drains into the lower-pressure pulmonary veins, so the microfiltration pressure is lower
What is the function of the parietal pleura?
Forms pleural fluid