9/24- Cases: Pulmonary Vascular and Pleural Flashcards Preview

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Flashcards in 9/24- Cases: Pulmonary Vascular and Pleural Deck (13)
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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?

- TB

- Malignancy


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

Pulmonary HTN

- 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)

5. Misc


What can cause PAH?

- Idiopathic

- Scleroderma (connective tissue diseases)


What structure is seen here?

Pulmonary artery

- 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