Pleural effusion with the following properties suggests what?
- Bloody on inspection
- Protein of 3.1
- LDH of 600 with 90% lymphocytes
[(Serum protein 4.6, LDH 275 (nl. 200-300)]
- pleural/serum > 0.5
- pleural/serum LDH > 0.6
- pleural LDH > 2/3 upper limit of normal
He meets all 3 Light's criteria, thus this is exudative
What CXR characteristic to check for things outside lung?
Mediastinal windows on XR
- Won't see lungs
What does lymphocyte-predominant exudate indicate?
What conditions cause very low glucose?
Bad parapneumonic effusion
What is shown here?
Small cell carcinoma
- Dark blue/purple
- Large, irregular cells
What do these symptoms suggest?
- Progressive SOB
- Elevated JVD, prominent RV heave, loud P2, systolic murmur in tricuspid area, trace pedal edema
- No chest pain, cough, or fever
- Right sided heart failure
What is shown here?
Enlarged pulmonary arteries
- Suggestive of pulmonary HTN
What do these PFTs suggest?
- FEV1/FVC is within normal range (and not under 70); not obstruction
- FEV1 and FVC both > 80%
- RV is 92% (normal), no restriction
- DLCO is 51%; still very low when corrected for alveolar wall
Thus, normal spirometry and normal lung volume with isolated low DLCO
What is the classic PFT for Idiopathic Pulmonary Arterial HTN?
- Normal PFTs and lung volume
- Isolated low DLCO
What diagnostic tests should be done for the different classes of pulmonary HTN?
1. Idiopathic PAH: Labs, serology
2. Heart disease: ECHO
3. Pulmonary disease +/- hypoxia: PFTs, Polysomnogram (sleep apnea)
4. Chronic Thromboembolic (CTEPH): spiral CT, V/Q scan (for small/chronic)
What can cause PAH?
- Scleroderma (connective tissue diseases)
What structure is seen here?
- Tunica media hypertrophy
- Intimal fibrosis of vascular bed
- In situ thrombosis*
*(this is in small pulmonary arteriole, not large level from thromboembolic condition)
What do the following symptoms suggest?
- Cross country road trip
- Tachypnea, without
- Edema of one leg
- O2 saturation 82% on RA
DVT -> Pulmonary embolism