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8. Respiratory > Pleural Effusion and Other Pleural Disease > Flashcards

Pleural Effusion and Other Pleural Disease Flashcards

1
Q

Define pleural effusion.

A

Accumulation of an abnormal volume of fluid in the pleural space

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2
Q

Describe the normal pleural fluid. (3)

How much is there?

A

Volume: <15ml
Clear, serous liquid
Contains few cells

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3
Q

Define a small pleural effusion.

Define a large pleural effusion.

A

Small: <500ml

Large: 500+ml

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4
Q

Describe the clinical features of pleural effusion.

What are the symptoms? (4)

What are the signs O/E? (3)

What would you see on chest imaging that strongly suggests pleural effusion? (1)

A 
SYMPTOMS:
Asymptomatic
Breathlessness
Cough
Chest pain

SIGNS O/E:
Stony dull percussion
Reduced breath sounds
Reduced vocal resonance

IMAGING:
Blunting of costophrenic angles

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5
Q

Describe the pathophysiology of pleural effusion. (3)

A
  1. Balance between pleural fluid production and absorption is disturbed
  2. This causes accumulation of fluid in the pleural space
  3. This causes increased hydrostatic pressure
    a. This eventually leads to congestive heart failure
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6
Q

What are the different mechanisms of pleural effusion pathogenesis?

i.e.

How can pleural effusion be caused? (6)

A

Increased hydrostatic pressure
Decreased osmotic pressure
Increased vascular permeability
Decreased lymphatic drainage
Increased intra-pleural negative pressure
Transdiaphragmatic passage of ascites from abdomen

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7
Q

List 2 other types of fluid which might be found in a pleural effusion.

A

Blood (haemothorax)
Chyle (chylothorax)

This is RARE

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8
Q

List 3 common conditions which can cause pleural effusion.

A

Congestive heart failure
Chronic liver disease
Pneumonia

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9
Q

How would you investigate a pleural effusion? (5)

A 
Clinical history
Clinical features
Pleural fluid analysis
Imaging
Pleural biopsy
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10
Q

What 5 types of test will you do in pleural fluid analysis?

A 
View on ultrasound
Colour of fluid
Biochemical tests
Microbiology
Cytology
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11
Q

What types of biochemical test would you to classify type of pleural effusion? (5)

A 
Protein levels
LDH
Glucose
Amylase
pH of fluid (if suspected infection)
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12
Q

List 3 methods of pleural biopsy.

A

Under CT/US guidance
Abram’s needle biopsy
Thorascopy

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13
Q

How is an Abram’s needle pleural biopsy carried out?

List 2 indications for this procedure.

A

METHOD:

  1. Large needle inserted under US guidance
  2. Inner sheath of needle takes biopsy

INDICATIONS:
Suspicion of pleural TB
Diffuse pleural involvement

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14
Q

How is a thorascopy done? (2)

What are the advantages of this procedure? (3)

List 1 indication for this procedure.

A

METHOD:

  1. Local anasthesia and mild sedation given
  2. Parietal/visceral pleura and diaphragm viewed with a thorascope

ADVANTAGES:
Direct visualisation of pleura
Biopsy of abnormal areas
Therapeutic manoeuvres can be done (e.g. drainage, pleurodesis)

INDICATIONS:
Undiagnosed cytology negative pleural effusion

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15
Q

What are the 2 types of pleural effusion?

A

Transudate

Exudate

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16
Q

Which criteria are used to define an exudative pleural effusion?

Describe them. (3)

A

Light’s criteria:

High protein/LDH (2/3+ upper limit of normal serum values)
Pleural:serum protein ratio: 0.5+
Pleural:serum LDH ratio: 0.6+

(i.e. exudative = high protein)

17
Q

List 4 common causes of a transudate pleural effusion.

A

Heart failure
Hepatic cirrhosis
Nephrotic syndrome
Hypoalbuminaemia

18
Q

List 4 causes of an exudative pleural effusion.

A

Bacterial pneumonia
Malignancy
Mesothelioma
TB

19
Q

On a pleural biopsy, what are 3 abnormal histological features seen in mesothelioma?

A 
Asbestos bodies (containing iron)
Mesothelial layer more than 1 cell thick
Mesothelial layer is not smooth/invades into chest wall
20
Q

Describe the criteria for diagnosing mesothelioma. (4)

A

Morphological malignant cells

Invasion of chest wall

Morphologically normal cells BUT with abnormal architecture

Morphology and architecture normal BUT with fibrosis

21
Q

How would you diagnose mesothelioma with immunocytochemistry tests? Consider:

a) Positive markers (2)
b) Negative markers (3)

A

POSITIVE:
Calretinin
CK 5/6

NEGATIVE:
TTF-1
BEREP-4
CEA (carcinoma embryonic antigen)

22
Q

What features of pleural effusion would you see on a chest x-ray? (3)

A

Blunting of costophrenic angles
Meniscus sign
Homogenous opacity

23
Q

Which 3 imaging modalities would you use for pleural effusion?

A

CXR
Ultrasound
CT

24
Q

Define asbestosis.

A

Diffuse interstitial fibrosis of the lung caused by asbestos dust

25
Q

Describe the clinical features of asbestosis.

What are the symptoms? (4)

What are the signs on imaging? (1)

A 
SYMPTOMS:
Progressive SOB
Dry cough
Bibasalar inspiratory crackles
Finger clubbing

SIGNS ON IMAGING:
Lower zone fibrosis on CXR

8. Respiratory (14 decks)

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