Week 4 - Pleural Disease Flashcards
Where is the pleural cavity most negative?
apex
What is hydropneumothorax?
mix of fluid and air in pleural cavity
What is pleural effusion Exudate vs Transudate?
- Exudate has a high protein content, transudate does not.
- Exudate is inflammatory, transudate is not - process of filtration
What is a common cause of transudate?
left ventricular failure, liver failure, kidney failure. they increase capillary pressure, causing filtration of fluid out
What are common causes of exudate?
pulmonary causes.
- malignancy,
- parapneumonic effusion (most common),
- empyaema,
- TB
How do you investigate a pleural effusion?
Ultrasound is more sensitive than CXR sensitive for pleura. CT used to detect complex effusions - thickening of pleura and mediastinal and vascular structures
How do you analyse pleural fluid?
- aspiration.
- ABG to see if acidic or not,
- microbiology lab for microorganisms,
- biochem lab for protein,
- cytology for general cells to help decision making
What LDH and Glucose levels would you expect to find in a pleural effusion?
high LDH and low glucose
When may you drain the fluid?
- if pH is below 7.2,
- has pneumonia,
- blood/pus
What step should you take if its transudate?
treat underlying cause and it should fix the effusion
What step should you take if its exudate?
unless cause is found, further imaging and biopsies needed to know what to do
What is primary spontaneous vs secondary spontaneous pneumothorax?
primary - out of nowhere in someone with normal lungs. secondary - in someone with pre-existing lung condition (asthma, COPD, CF)
What is a cause and process of primary spontaneous pneumothorax?
bleb in lung bursts suddenly, causing air accumulating and compressing lung
What is a traumatic pneumothorax?
after injury to chest wall - broken rib pierces it, stabbing.
What is an iatrogenic pneumothorax?
occurs in hospital - biopsy, venous line etc accidentally pierces lung
What is a tension pneumothorax? When may it occur?
air in pleural cavity builds up and squashes contralateral heart and lung. other lung compressed leads to lower O2 levels. pressure on heart means doesnt fill well - BP drops. need emergency aspiration. may occur following mechanical ventillation
What are the symptoms of a spontaneous pneumothorax?
sudden onset breathlessness and chest pain - may be mistaken for gym muscle pain
What presentation would you expect to see in a pneumothorax?
- tachypneic,
- hypoxic,
- reduced chest wall movements,
- little to no breath sounds.
MAY be totally normal
How is a pneumothorax diagnosed?
CXR detects large one. air rises to top of lung so small one may not be seen. ultrasound may be used if patient too sick to get up. CT for complex cases.
How is pneumothorax managed?
Patient specific. may need apsiration, may resolve itself. chest drain insertion.
What is the recurrence rate and what should you follow post-operatively?
25-50% chance within a year.
if recurs on same side, surgery may be required
no heavy weights or flying for a week.
What is the triangle of safety?
area on body (armpit area) which identifies safe spot when inserting chest drain or doing surgical procedures
What do most pleural tumours present as? what is the outcome?
Pleural effusion. Poor outcome
Which type of malignancy in the pleura is most commmon?
secondary. primary isn’t common. secondary may be from lung, breast, ovary, GI or thyroid
How does a tumour actually metastasise the pleura? (2)
- either studs the surface or
- enters lymphatics and blocks drainage of lung, causing pleural effusion
What is the most common primary malignancy of the pleura and how does it arise?
mesothelioma. rare, agressive, occupational tumour. asbestos fibres reach pleura and cause inflammation. lays latent for 20-40 years.
What are the symptoms of mesothelioma?
- chest pain,
- breathlessness,
- weight loss,
- clubbing,
- pleural effusion signs
what screening methods are used to stage and diagnose pleural tumours?
CT sees pleural surface in detail. tissue needed to diagnose mesothelioma - not fluid. CT and biopsy can stage. Thoroscopy - visualise and get samples directly
How is mesothelioma managed?
its incurable and survival is poor. chemo is for a select few individuals, but has very little benefit to offer.
What is pleurodesis?
closing pleural space with talc powder to palliate issue and stop fluid reaccumulating
What is decortication?
picking off layers of thickened pleura to allow underlying lung to expand and relieve breathlessness
What causes low glucose levels in pleural fluid analysis?
Infection, empyema, malignancy, rheumatoid arthritis
What must be carried out prior to an ultrasound guided biopsy for a pleural malignancy?
- Spirometry for lung function as pneumothorax is common
- full bloods for platelet check
