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Pulm > SM_172a: Pleural Disease > Flashcards

SM_172a: Pleural Disease Flashcards

1
Q

Describe the histology of the pleura

A

Meosthelial cells bordering pleural space, then connective tissue, then alveolar space

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2
Q

______ pleura lines the lung, while ______ pleura lines the chest wall

A

Visceral pleura lines the lung, while parietal pleura lines the chest wall

(pleural space is between the two)

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3
Q

There are ____ pleural spaces

A

There are 2 pleural spaces

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4
Q

Pleural fluid is formed in the _______ pleura

A

Pleural fluid is formed in the parietal pleura

  • Visceral pleura is thicker
  • Visceral pleura drains into low pressure pulmonary veins, while parietal pleura drains into systemic veins
  • Parietal pleura has lymphatic stoma
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5
Q

What is the Frank-Starling equation?

A
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6
Q

Describe pleural fluid flow

A
  • Hydrostatic pressure high in small capillaries in parietal pleura which causes fluid to move into pleural space
  • Lymphatic stoma draw fluid back into lymphatic drainage system
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7
Q

Pleural effusion forms as a result of an imbalance between _____ and _____

A

Pleural effusion forms as a result of an imbalance between pleural fluid filtration and pleural fluid clearance

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8
Q

What are the 5 factors that can lead to pleural effusion?

A
  • Increased microvascular hydrostatic pressure (congestive heart failure)
  • Decreased microvascular oncotic pressure (nephrotic syndrome)
  • Obstruction to lymphatic drainage (malignancy)
  • Decreased pleural space pressure (trapped lung)
  • Increased permeability of capillaries or pleural lining (parapneumonic effusion)
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9
Q

Describe the presentation of pleural effusion

A
  • Often asymptomatic
  • Cough
  • Dyspnea
  • Dullness to percussion
  • Decreased breath sounds
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10
Q

What is a tension pleural effusion?

A
  1. One hemothorax fills up with fluid
  2. Exerts mass effect on mediastinum
  3. Impedes venous drainage and right and left heart filling
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11
Q

What is the CXR finding corresponding to pleural effusion?

A

Dense opacification w/ meniscus sign (layering of fluid)

(need confirmatory testing to determine how much is pleural fluid and how much is atelectasis, CXR can also miss pleural effusion)

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12
Q

Which arrow represents an pleural effusion?

A

Middle arrow (anechoic space represents pleural fluid)

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13
Q

______ is the procedure used to evaluate pleural effusion

A

Thoracentesis is the procedure used to evaluate pleural effusion

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14
Q

What are Light’s criteria?

A

Pleural effusion is exudative if any one of the following is true:

  • Pleural fluid total protein / serum total protein > 0.5
  • Pleural fluid LDH / serum LDH > 0.6
  • Pleural fluid LDH > 2/3 of upper normal value of serum LDH
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15
Q

If at least one of the Light criteria for pleural effusion is met, the pleural effusion is ______

A

If at least one of the Light criteria for pleural effusion is met, the pleural effusion is exudative

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16
Q

______, ______, and ______ are causes of transudative pleural effusions

A

CHF, cirrhosis, and nephrotic syndrome are causes of transudative pleural effusions

17
Q

_______, _______, _______, _______, and _______ are causes of exudative pleural effusions

A

Parapneumonic, malignancy, autoimmune disease, pulmonary embolism, and pancreatitis are causes of exudative pleural effusions

18
Q

What additional testing is done for exudative pleural effusions?

A
  • Cell count
    • Neutrophilic: infection (likely bacterial)
    • Lymphocytic: malignancy, TB, autoimmune disease
  • pH: if <7.2 consider chest tube drainage b/c likely active infectious process
  • Glucose
  • Cultures
  • Cytology
19
Q

A neutrophilic exudative effusion is suggestive of a _____

A

A neutrophilic exudative effusion is suggestive of a bacterial infection

20
Q

A lymphocytic exudative effusion is suggestive of _____, _____, or _____

A

A lymphocytic exudative effusion is suggestive of malignancy, TB, or autoimmune disease

21
Q

The more acidic the exudative pleural fluid is, the more we are concerned about an ______

A

The more acidic the exudative pleural fluid is, the more we are concerned about an active infectious process

22
Q

_____ is purulent infection in the pleural space and an indication for chest tube

A

Empyema is purulent infection in the pleural space and an indication for chest tube

23
Q

______ is triglyceride-rich fluid in the pleural space and most often results from injury to the ______

A

Chylothorax is triglyceride-rich fluid in the pleural space and most often results from injury to the thoracic duct

24
Q

Describe the approach for diagnosing/sampling pleural effusion

A
25
Q

______ is air in the pleural space

A

Pneumothorax is air in the pleural space

  • Types: primary spontaneous, secondary spontaneous, traumatic/iatrogenic
26
Q

Describe the characteristics of primary spontaneous pneumothorax

A

Primary spontaneous pneumothorax

  • No underlying lung pathology
  • No inciting event
  • Young thin patients
  • Recurrent rate high
27
Q

Secondary spontaneous pneumothorax is spontaneous pneumothorax in the setting of ______

A

Secondary spontaneous pneumothorax is spontaneous pneumothorax in the setting of underlying lung disease

28
Q

What is trapped lung?

A

Visceral pleura become inflamed, hypertrophied, and scarred -> impede lung expansion

29
Q

Describe the imaging modalities using to diagnose pneumothorax

A
  • Chest CT: gold standard
  • CXR: acceptable if pneumothorax is moderate-large
  • Ultrasound: increasingly utilized
30
Q

The ultrasound finding diagnostic of pneumothorax is ______

A

The ultrasound finding diagnostic of pneumothorax is lung point

(half of pleura moving and half not moving)

31
Q

Describe what occurs in an open pneumothorax

A
  • Continuous connection between chest wall and atmosphere
  • Pressure in intrapleural space will not get too high b/c air can flow in, causing pressure to equilibrate
32
Q

Describe what occurs in a closed pneumothorax

A

Injury acts like a ball valve

  • Air continues to fill up pleural space -> pressure becomes more positive -> impedes venous return and right and left heart filling -> pneumothorax

(concerned about pneumothorax when on positive pressure b/c intrapleural pressure rapidly exceeds pressure needed for venous return)

33
Q

In tension pneumothorax, intrapleural pressure _____ atmospheric pressure, shifting trachea away from the affected side

A

In tension pneumothorax, intrapleural pressure rises above atmospheric pressure, shifting trachea away from the affected side

34
Q

Subcutaneous emphysema is when ______ and is treated by ______

A

Subcutaneous emphysema is when air dissects bronchovascular bundles and enters into tissue and is treated with needle decompression

Pulm (32 decks)

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