3. Pleural, Mediastinal diseases Flashcards
What are the diseases of the pleura (4)
- effusion (fluid in pleural space)
- Pneumothorax/hydropneumothorax
- Calcification
- Tumor
Causes of pleural effusion bilaterally (+mc)
- Congestive Heart failure (mc)
- Cirrhosis w ascites
- nephrotic syndrome
- kwashiorkor
causes of pleural effusion unilaterally
*more exudate causes
- Malignancy
- Infections
- Autoimmune diseases
- Infarction
- Trauma
- Surgery
When can you see pleural effusion on X-ray and mediastinal shift (in mL)
Seen on X-ray >300ml
Mediastinal shift >1000ml
what is the meniscus sign
when costophrenic angles become blunted in pleural effusion
What breath sounds will u get in pleural effusion
decreased breath sounds
Features of subpulmonic effusion
dome more flat
-may be more central effusion as you can kinda still see angles
if you see bilateral blunting what most likely is the cause
Heart issues
physical exam findings in pleural effusion
- decreased/inaudible breath sounds
- tachypnea
- egophony/pleural rub
- asymetric expansion of thoracic cage
- dullness to percussion
- decreased or absent tactile fremitus
how to tx common (3, CHF, Infection, reumo) pleural effusion conditions
treat underlying cause
CHF- Diuretics
Infection- Antibiotics
Rheumatological and inflamatory causes-steroids and NSAIDs
causes of pleural calcification
Asbestosis (mc)
Old empyema
causes of pleural calcification
Asbestosis (mc) Old empyema Old hemothorax Old TB Silicosis
Signs of an extra plural entity
Peripheral density
convex toward lung
sharp inner margin (and indistinct outer margin)
Obtuse angle w chest wall (cat under the rug)
causes of extra pleural sign
- rib fracture (mc)
- callous
- hematoma
- rib expansile lesion
radiographic findings of rib fractures
- Radiolucent fracture line
- cortical offset
- altered rib orientation
- pleural deflection
- callus
- pneumothorac
what will you see in a pneumothorax
Well defined density near hilum (collapsed lung)
-no pleural markings anywhere else
Types of pneumothorax
Primary (spontaneous)- Young males/tall/thin, most liekly small but could progress to tension type
Secondary- result of trauma or underlying disease
Hydropneumothorax
Tension
mc disease cause of secondary pneumothorax
COPD
physical exam findings of affected side in pneumothorax
- diminished breath sounds
- hyperresonate on percussion
- decreased vocal resonance and tactile fremitus
What lobe is pneumothorax mc
Upper lobe
What is a tension pneumothorax and management
- Complete collapse of the lung
- Air enters pleural space and gets trapped
- air cannot escape
- can lead to hypotension,shock,death
SURGICAL EMERGENCY
Key signs of tension pneumothorax (3)
- squeezes lung into formless shadow along spine
- oftern displaces the mediastinum away from the side of collapse
- may invert diaphragm
Clinical findings of tension pneumothorax (4)
- distressed + pain
- Reduced chest expansion
- Tachycardia
- Hyperresonance to percussion and diminished breath sounds on involved side
What is the big sign in a hydropneumothorax
Presence of air and fluid within pleural space
look for the straight air/fluid line
