Pleural Malignancy

Question 1

What is a pleural effusion?

Answer 1

Abnormal collection of fluid in the pleural space. Slide 8

Question 2

What are the pleural fluid appearances if there has been cardiac failure or if it is foul smelling?

Answer 2

Straw coloured for heart failure and anaerobic empyema if foul smelling. Slide 17

Question 3

What is a transudate and what are the causes?

Answer 3

Extravascular fluid low in proteins and can be caused by heart failure, liver cirrhosis. Slide 18

Question 4

What is exudates?

Answer 4

Fluid around cells due to inflammation high in proteins and can be caused by malignancy and infection. Slide 18

Question 5

Is glucose high or low in infection, TB, malignancy etc.?

Answer 5

Low. Slide 19

Question 6

How many times maximum should you repeat a thoracentesis (pleural tap)?

Answer 6

2 times max. Slide 29

Question 7

What are some reasons why a pleural biopsy will come back negative?

Answer 7

The technique was wrong and the biopsy didn’t contain pleura.
The pleural disease was discontinuous on the pleura.
The pleural effusion isn’t malignant itself. Slide 35

Question 8

If a patient was exposed to asbestos at any point what does this mean they have an increased likelihood of?

Answer 8

Developing mesothelioma. Slide 43

Question 9

What are the treatment options for a malignant pleural effusion?

Answer 9

Palliate symptoms
Drain or pleurodesis (Talc slurry)
Long term catheters
Surgical options. Slide 49

Question 10

What are complications of talc?

Answer 10

Minor pleuritic pain, pneumonia, fever. Slide 51

Question 11

How can a tension pneumothorax occur?

Answer 11

Trauma, ventilated patient, misplaced drain. Slide 75

Question 12

What are signs of a pneumothorax?

Answer 12

Trachea deviated to opposite side, hypotension, raised JVP. Slide 74