W4 - Effusion, Pneumothorax & Mesothelioma Flashcards
What is the most common primary malignancy of pleura?
Mesothelioma
Are primary or secondary pleural tumours more common?
Primary
Name 2 characteristics of mesothelioma
Rare
Aggressive
Name 2 causes of mesothelioma
Occupational lung disease (so more common in men)
Inhaled asbestos dust/fibres
Name 6 occupations which mesothelioma occurs in
Plumbers
Electricians
Shipbuilding
Power plants
Boilers
Engines
Name 5 symptoms of mesothelioma
Chest pain
SOB
Weight loss
Clubbed, pleural effusion
Palpable neck nodes
Name 2 types of diagnosis for mesothelioma
CXR to look for pleural effusion and mass
Biopsy to stage
Name 3 types of biopsy used to stage mesothelioma
Blind pleural biopsy using Abram’s pleural needle
CT guided/US biopsy
Thorascopy - can also spray talcum (pleurodesis) to stop fluid reoccuring
Describe 6 management options for mesothelioma
Palliative care
Treat effusion
Chemo
Recruit to trials via MDTs
Palliative surgery
Advise patient about compensation
Describe the outlook for mesothelioma
Limited, survival poor
Name 2 palliative surgeries for select patients with mesothelioma
Pleurodesis in young patients
Decortication (peeling off thickened pleura) to relieve SOB
Define pneumothorax
Collection of air between visceral and parietal pleura
Is pneumothorax restrictive or obstructive?
Restrictive
Name 5 types of pneumothorax
Primary spontaneous
Secondary spontaneous
Traumatic
Iatrogenic
Tension
Define primary spontaneous pneumothorax, it’s believed cause and effect
Out of the blue pneumothorax in normal lungs. Believed to be due to weak areas on lung surface called “blobs” which rupture spontaneously an leak air into pleural cavity, compressing underlying lung.
Define secondary spontaneous pneumothorax and 6 related conditions
Out of the blue pneumothorax in someone with a pre-existing condition. Usually condition is:
Interstitial lung disease
COPD
Asthma
Cystic fibrosis
and rarely pleural endometriosis
Name 6 presentations of pneumothorax
Sudden event
Chest pain
SOB
Tall thin young men
Sometimes underlying lung disease
History of biopsy/line insertion/mechanical ventilation
Name 6 signs of pneumothorax
Tachypnoeic
Hypoxic
Reduced chest movement
Reduced/no breath sounds
Hyper-resonant percussion
Or exam may be normal!
Name 3 investigations for pneumothorax
CXR
US
CT thorax
Name 4 managements of pneumothorax
Watch and wait if they look well
Aspiration if over 2cm but well
Chest drain insertion
Surgery if recurrent/unresolving
What’s the risk of recurrence of pneumothorax within the first year?
25-50%
Following pneumothorax treatment, what 2 things should you advise a patient?
Avoid heavy lifting and flying for 1+ week
Define pleural effusion
Excessive collection of fluid between parietal and visceral pleura
Name the 2 types of pleural effusion
Transudate effusion - non-inflammatory
Exudate effusion - inflammatory
How can we tell if effusion is transudate or exudate effusion?
Apply the Lights criteria
Give the 3 Lights Criteria and whether they tell us which effusion we’re faced with
1) Protein - plural fluid to serum fluid ratio >0.5
2) Serum Lactate Dehydrogenase (LDH) - pleural fluid / serum fluid ratio >0.6
3) Pleural fluid LDH > 23 ULN serum LDH
If no criteria met, transudate effusion, otherwise exudate effusion
In what 2 ways does transudate effusion present?
Bilateral
Subcutaneous oedema
What is the difference between transudate and exudate fluid?
Transudate - low protein content
Exudate - 3g/dl or more protein content
Name 2 common causes of transudate effusion
Left ventricular failure
Liver cirrhosis
How do we diagnose and treat transudate effusion?
Treat underlying cause
May not need CT
Name 4 common causes of exudate effusion?
Malignancy (pulmonary or not)
Parapneumonic effusion
Empyema
TB
How do we treat exudate effusion
Unless cause is identified, will need further investigation (e.g. imaging) and/or pleural biopsy
When might we need a chest drain with pleural effusion
pH less than 7.2 with pneumonia/blood/pus
Name 4 investigations for pleural effusion
US
CXR
CT thorax
Pleural fluid analysis
Name 6 types of pleural fluid analysis for effusion
Aspiration
Inspect fluid
pH (bedside ABG machine)
Biochemistry
Microbiology
Cytology
