CP9 pleural pathology

Question 1

What are 5 common pleural pathologies?

Answer 1

Inflammation (aka pleurisy)
Pleural effusion
Pneumothorax
Pleural fibrosis
Mesotheliomas

Question 2

What are the two layers of pleural called?

Answer 2

The parietal pleura and the visceral pleura

Question 3

What two layers are the pleura formed of?

Answer 3

Connective tissue layer
Mesothelium layer

Question 4

Which layer of the pleura line the pleural cavity?

Answer 4

Mesothelium

Question 5

What are characteristics of a normal Mesothelium?

Answer 5

A single layer of mesothelial cells which secrete hyaluronic acid to lubricate movement of the pleura against each other during respiration.

Question 6

What are symptoms of pleurisy?

Answer 6

Recent onset sharp chest pain that is exacerbated by deep breathing, coughing or sneezing. Also history of breathlessness

Question 7

What is a clinical sign of pleurisy?

Answer 7

Hearing plural rub upon auscultation

Question 8

What investigations are involved in diagnosing pleurisy?

Answer 8

Blood test
Chest x-ray
CT or ultrasound
Biopsy

Question 9

What are common causes of pleurisy?

Answer 9

Infection (most commonly viral but can also be bacterial)
Pulmonary infarction (can be due to PE)
Emphysema
Neoplasms
Therapeutic/iatrogenic
Collagen vascular disease

Question 10

How is pleurisy treated?

Answer 10

Treat the cause
NSAIDs

Question 11

What are clinical signs of pleural effusion?

Answer 11

Stony dullness upon percussion
Reduced breath sounds upon auscultation

Question 12

What is it called when serous fluid is in the pleural cavity?

Answer 12

Pleural effusion

Question 13

What is it called when pus is in the pleural cavity?

Answer 13

Empyema or phyothorax

Question 14

What is a common cause for pus in the pleural cavity?

Answer 14

Pneumonia

Question 15

What is it called when blood is in the pleural cavity?

Answer 15

Haemothorax

Question 16

What are the most common causes of haemothorax?

Answer 16

Trauma and ruptured thoracic aortic aneurysms

Question 17

What is it called when there is bile in the pleural cavity?

Answer 17

Chylothorax

Question 18

What is the most common cause of bile in the pleural cavity?

Answer 18

Trauma

Question 19

What is it called when there is air in the pleural cavity?

Answer 19

Pneumothorax

Question 20

What white blood cell will be increased in the results from a blood test for a pleural effusion?

Answer 20

Neutrophils

Question 21

What are the two types of pleural effusion?

Answer 21

Transudates
Exudates

Question 22

What are 3 properties of transudate pleural effusions?

Answer 22

1. Low capillary oncotic pressure +/- high capillary hydrostatic pressure.
2. Intact capillaries which retain semipermeability
3. Low protein (<

Question 23

What are 3 properties of exudate pleural effusions?

Answer 23

Pathological capillaries lose semipermeability
Capillary oncotic pressure and vascular hydrostatic pressure is normal
High protein (>2.9 g/dL)
High lactate dehydrogenase

Question 24

What causes transudate pleural effusions?

Answer 24

Left ventricular failure
Renal failure
Hypoalbuminaemia due to hepatic cirrhosis or nephrotic syndrome

Question 25

What causes exudate pleural effusions?

Answer 25

Inflammation with/without infection e.g. empyema Primary or secondary neoplasms

Question 26

How can you treat pleural effusions?

Answer 26

Relieve symptoms Remove fluid (by aspiration or a drain) Pleurodesis (stick lung to chest wall) Treat the cause Investigate the pleural fluid with cytology, microbiology and biochemistry (Can also do CT scan/ultrasound +/- pleural biopsy)

Question 27

What are symptoms of pneumothorax?

Answer 27

Breathlessness and pleuritic chest pain

Question 28

What are clinical signs of a pneumothorax?

Answer 28

Cyanosis Tachycardia Contra lateral tracheal deviation (in tension pneumothorax) Hyper resonance upon percussion Reduced breath sounds upon auscultation

Question 29

What are the two types of pneumothorax? Where does the air come from for each?

Answer 29

Closed (air from inside the lung) Open (air from outside of the lungs)

Question 30

What are causes of a closed pneumothorax?

Answer 30

Ruptured emphysematous bullae Inflammatory lung diseases e.g. asthma, pneumonia, TB and CF Trauma where lung torn by fractured rib

Question 31

What causes an open pneumothorax?

Answer 31

Trauma causing a chest wall perforation (aka a sucking chest wound) causing external air to enter the pleural cavity during inspiration reducing potential lung expansion

Question 32

What causes a tension pneumothorax?

Answer 32

Valvular perforation causing air into the lung cavity during inspiration but not out again on expiration Pressure build up in a pneumothorax causing compression of the lung

Question 33

How are pneumothorax managed/treated?

Answer 33

Can spontaneously decompress Manually decompressed via needle aspiration via intercostal space Occlusive adhesive dressing +/- valve Chest drain +/- valve Pleurodesis

Question 34

What are 2 causes of pleural fibrosis?

Answer 34

Pleural inflammation Asbestos (causing parietal fibrous plaques or diffusing across the pleura)

Question 35

What are parietal pleural fibrous plaques?

Answer 35

Dense areas of poor cellular collagen on pleura associated with low level asbestos exposure

Question 36

What is diffuse parietal fibrosis?

Answer 36

High level asbestos dust exposure causing bilateral (usually) fibrosis. The dense cellular collagen does not extend into the interlobar fissures

Question 37

What are symptoms of diffuse pleural fibrosis?

Answer 37

Breathing difficulties

Question 38

What is a treatment used for diffuse pleural fibrosis?

Answer 38

Pleural decortication

Question 39

What are the two main types of primary pleural cancers?

Answer 39

Low grade mesothelial tumours (benign) Malignant mesothelioma

Question 40

What is the most common secondary tumour in the pleura?

Answer 40

Carcinomas

Question 41

Who is most likely to be affected by low grade peritoneal mesotheliomas?

Answer 41

Women

Question 42

What is a consequence of a pleural effusion as a result of malignant mesotheliomas?

Answer 42

The tumour can metastasise into the effusion

Question 43

What is the main cause of malignant mesothelioma?

Answer 43

Asbestos - the longer the exposure, the higher the cancer risk

Question 44

What are the less common causes of malignant mesotheliomas?

Answer 44

Spontaneous tumour development (very rare) Thoracic irradiation BAP1 mutations (familial cancer syndrome)

Question 45

What are the 3 main types of asbestos?

Answer 45

Blue Brown White

Question 46

What is asbestos?

Answer 46

Fibrous metal silicates that when inhaled forms asbestos bodies

Question 47

What are the 7 main asbestos related diseases?

Answer 47

Pleural effusion Parietal pleural fibrous plaques Diffuse pleural fibrosis Malignant mesotheliomas Asbestosis Lung carcinomas Asbestos corns (benign war like skin lesions)