Week 4: Pleural Disease & Smoking Flashcards
Describe the causes and clinical features of pleural effusion
- production/absorption imbalance
1. TRANSUDATE ↓protein, non-inflamm => ORGAN FAILURE
2. EXUDATE: ↑protein, inflammation more than 3g/dl => pulmonary causes
Define the problems in differential diagnosis of pleural effusion.
wide range of differentials d/t organ failure involvement, cancer, infection, PE
Describe the pathology and resulting presentation of typical malignant mesothelioma.
clubbing, Wt loss, CXR/CT/ TISSUE ESSENTIAL!
- M>F, asbestos, prolonged inflamm.
- 2º mets
Tx difficult d/t poor fitness of Pt
Define the approach to investigation of a pleural effusion
- Bedside USS
- CXR
- CT Thorax
- Fluid analysis: pH, microbiology, cytology, pus, blood
a pleural fluid ph of less than 6.0 is indicative of
empyema (purulent fluid collection in the pleural space) progression and requires chest draining (7.2-7.3)
Define the approach to investigation of a pleural effusion
- Bedisde USS
- CXR
- CT Thorax
pleural plaques & main association
hyalinized collagen fibers and form in the pleura. They are the most common sign of asbestos exposure. Asymptomatic
empyema and malignant pleural mesothelioma
MPM disrupts lung architecture giving rise to higher risk to recurrent infection and inflammation giving rise to empyema. Therefore widespread MPM disrupt and give rise to widespread empyema.
Malignancy can be detected in the empyema fluid.
1º and 2º Spontaneous Pneumothorax
1º = Normal. Blebs on lung surface rupture
2º = Lung disease. Genetic predisposition
Other types of Pneumothorax
- Traumatic: rib fracture etc.
- Iatrogenic: biopsies, central lines, ventilator pressure
- TENSION: build up of pressure displaces central structures and therefore displaces on contralateral lung, as a result of trauma or ventilators.
Pneumothorax Tx
- PLEURAL DRAIN: 2nd intercostal space midclavic.
- aspiration
- CHEST DRAIN (air, fluid, blood, pus)
- SURGERY
