THORACIC Section 14: Pleura, Chest Wall

Question 1

If they show you a pleural plaque, they probably want to say what related type of disease?

Answer 1

Asbestos-related

Question 2

Asbestos plaques show up how many years after exposure?

Answer 2

20-30 years.

Question 3

Most common cancer of the pleura.

Answer 3

Malignant Mesothelioma.

Question 4

Key features of Malignant Mesothelioma?

Answer 4

Circumferential pleural thickening extending ot the meedial surface of the pleura. Near the hear.

Question 5

Malignant Mesothelioma that is highly suggestive of the disease?

Answer 5

Fissural extension.

Question 6

If the lateral pleural is thick? Most common cause is?

Answer 6

Prior trauma. Look for rib fractures.

Question 7

If the medial pleural is thick, think of what diseasE?

Answer 7

Mesothelioma

Question 8

A solitary (usually) tumor with no association with environmental exposures?

Answer 8

Solitary Fibrous Tumor of the Pleura

Question 9

What pleura does SFTP arise?

Answer 9

Visceral

Question 10

What syndrome is SFTP associated?

Answer 10

Doege-Potter Syndrome

This is an episodichypoglycemia (tumor can
secrete an insulin like growth factor

Question 11

This disease occurs in 30% of teh SFTP cases.

Answer 11

Hypertrophic Osteoarthorpathy

Question 12

Most common benign soft tissue of the pleura.

Answer 12

Lipoma.

Question 13

What neoplasm is likely to metastasize in the pleura?

Answer 13

AdenoCA

Question 14

2nd and 3rd most common primary in the pleural metastasis?

Answer 14

2nd - breast
3rd - lymphoma

Question 15

Most common manifestation of metastasis to the pleura.

Answer 15

Pleural effusion.

Question 16

Volume of fluid to be seen in frontal veiw xray.

Answer 16

175 cc.

Question 17

Volume of fluid to be seen in lateral xray.

Answer 17

75 cc

Question 18

Pleural fluid accumulating between the lung base and diaphragm

Answer 18

Subpulmonic effusion

Question 19

Sign of subpulmonic effusion on frontal xray?

Answer 19

Lateralization of the diaphragmati cpeak.

Question 20

Basically this is an infected pleural effusion

Answer 20

Empyema

Question 21

Empyema can occur with a simple pneumonia but is more in people with what condition?

Answer 21

AIDS

Question 22

When the empyema eats through the chest wall and into the soft tissues.

Answer 22

Empyema Necessitans

Question 23

Empyema Necessitans is seen in this condition (70%)

Answer 23

TB

Question 24

2nd most common cause of Empyema necessitans

Answer 24

Actinomyces

Question 25

Most common congenital diaphragmatic hernia

Answer 25

Bochdalek

Question 26

Posterior diaphragmatic hernia

Answer 26

Bochdalek (BACKdalek)

Question 27

Anterior diaphragmatic hernia

Answer 27

Morgagni

Question 28

Most common laterality on traumatic diaphragmatic henria

Answer 28

Left (Liver is a buffer)

Question 29

Abscess vs Epyema

Lentiform + Split Pleural sign (Thickening and separation of the visceral and parietal pleura) + CTT

Answer 29

Empyema

Question 30

Abscess vs Empyema

Round + Claw Sign (Acute angle with pleura) + No treated with CTT

Answer 30

Pulmonary abscess

Question 31

Risk of CTT on pulmonary abcess

Answer 31

Bronchopleural fistula

Question 32

Common cause of diaphragmatic paralysis

Answer 32

Idiopathic (70%)

Phrenic nerve compression from a lung cancer

Question 33

What should you look for in a sniff test on diaphragmatic paralysis?

Answer 33

Paradoxial movement (up on inspiration - instead of down)