Thoracic Surgery - Diseases of the Pleura

Question 1

What are the two types of pleural effusions and their etiologies?

Answer 1

1. Transudative - CHF, nephrotic syndrome, cirrhosis

2. Exudative - infection, malignancy, trauma, and pancreatitis

Question 2

What are Light’s criteria, whereby if at least one of the criteria is met, the fluid is defined as exudative?

Answer 2

Pleural fluid-to-serum protein ratio >0.5
Pleural fluid-to-serum LDH ratio >0.6
Pleural fluid LDH >2/3 upper limit of lab’s normal serum LDH

Question 3

Diagnostic test of choice for pleural effusion?

Answer 3

Thoracentesis (needle drainage) with pleural fluid studies, including cytology

Question 4

Treatment of pleural effusion?

Answer 4

1. Pigtail catheter or thoracostomy (chest tube)
2. Treat underlying condition
3. Consider sclerosis if malignant pleural effusion

Question 5

What is an empyema?What is the management?

Answer 5

Infected pleural effusion; must be drained, usually with chest tube(s)
Decortication may be necessary if tube thoracostomy drainage is incomplete

Question 6

What is a decortication?

Answer 6

Thoracotomy and removal of an infected fibrous rind from around the lung

Question 7

Causes of spontaneous pneumothorax?

Answer 7

Primary (idiopathic, or no cause identified)

Secondary (bleb disease/emphysema, rarely cancer)

Question 8

What body habitus is associated with primary spontaneous pneumothorax?

Answer 8

Thin and tall

Question 9

Rx spontaneous pneumothorax?

Answer 9

Chest tube or pigtail catheter

Question 10

Options for refractory, recurrent, or bilateral spontaneous pneumothorax?

Answer 10

Thoracoscopy with mechanical pleurodesis

Question 11

Who might also need a pleurodesis after the first episode?

Answer 11

Those whose lifestyles place them at increased risk for pneumothroax (pilots, scuba divers, etc.)

Question 12

What is a catamenial pneumothorax?

Answer 12

2/2 intrathoracic endometriosis