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Flashcards in Pleural Diseases Deck (25)
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1
Q

Abnml accumulation of fluid in pleural space

A

Pleural effusion

2
Q

Signs/Sxs (PEff)

A

Asx…
Dyspnea, cough
Dullness to percussion, Dec tactile fremitus, Dec BS

3
Q

Classification (PEff)

A

Transudates (Elevated pressures)

Exudates (Cancer, PNA)

4
Q

How to differentiate Transudate from Exudate

A
Light's Criteria:    Exudate
PF protein: serum protein > 0.5
PF LDH: serum LDH > 0.6 (or > 2/3)
SpGr > 1.020
Albumin lower, Cholesterol higher than blood
***Transudate - PF protein < 3gm
***Exudate - PF protein > 3gm
5
Q
Capillaries nml but inc fluid lost 2/2:
  inc hydrostatic press (CHF)
  dec oncotic press (dec albumin)
No local pleural damage
Clear fluid
Everything lower in PF x Albumin
Bilateral - always
A

Transudate

CHF, Cirrhosis, Nephrotic Syndrome, PE, Hypothyroidism

6
Q
Abnml capillaries (leaking fluid) 2/2:
  PNA
  Cancer ( dec lymphatic drainage)
Local pleural dz
Cloudy fluid
Everything higher in PF x Albumin
Bilateral or Unilateral
A

Exudate

Infxn (PNA, Empyema), Malignancy, Inflamm (RA, SLE), Pancreatitis, Trauma

7
Q

Exudate subtypes

A

Empyemas
Hemothorax
Chylothorax

8
Q

Direct infxn

Pus collection in pleural space

A

Empyema

9
Q

Gross blood in pleural space

From trauma

A

Hemothorax

10
Q

Thoracic duct disruption
Cholesterol complex accumulation (white)
Assoc c lymphoma or h/o thoracic surg

A

Chylothorax

11
Q

Dx (PEff)

A

CXR - trapped vs free, quantity
CT - to evaluate etiology
US-guided Thoracent (GOLD STND)
Fluid for prot./LDH - transudate vs exudate (other tests for subtype analysis)

12
Q

Tx (Transudate PEff)

A
90% 2/2 CHF
Underlying condition:
Diurese
ACEI/ARB
Thoracentesis for dyspnea
13
Q

Tx (Exudate PEff)

Assoc c PNA = Parapneumonic

A

Tx PNA
Classify effusion
Uncomplicated: free flowing; resolve c abx
Complicated: pleural peel/trap; CT/surgery
Empyema: abscess, multi-lobe; surgery

14
Q

Tx (Exudate PEff)

Assoc c malignancy

A

Treat cancer
Lung or breast ca MC; re-accumulate
Therapeutic thoracentesis (helps sxs)
Pleurodesis - scar c talc

15
Q

Air in pleural space

A

PTX

16
Q

Classification (PTX)

A

Spontaneous

Acquired

17
Q

PTX in absence of underlying dz

Tall, thin, male, smoker

A

Primary spontaneous PTX

18
Q

PTX as complication of underlying dz

COPD, asthma, CF

A

Secondary spontaneous PTX

19
Q

**MC type of PTX **

2/2 thoracentesis, central line, vent, CPR

A

Acquired - IATROGENIC

20
Q

PTX 2/2 penetrating or blunt trauma

A

Acquired - Traumatic

21
Q

PTX 2/2 mechanical ven

A

Acquired - Barotrauma

22
Q

Tracheal or mediastinal shift 2/2 PTX

commonly barotrauma or traumatic PTX

A

Tension PTX

23
Q

Signs/Sxs (PTX)

A

Ipsilateral CP
Dyspnea
Severity relates to size

24
Q

Dx (PTX)

A

CXR (expiratory)

CT (most sensitive)

25
Q

Tx (PTX)

A

Small (15%): CT, surgery, tx underlying cause