Lecture 4- CXR Effusions Flashcards

1
Q

Pleural Fluid Production

A
  • liquid originates from systemic vessels of pleural membrane (interstitial fluid)
  • avg volume of pleural fluid is 8.4mL per hemithorax
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Pleural fluid absorption

A
  • pleural liquid exits the pleural space via lymphatic stomata of parietal pleural
  • pleural pressure is lower than interstiail pressure of either pleural tissues so liquid can move out of pleural space
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what can cause pleural fluid accumulation

A
  • increased hydrostatic pressure (HF)
  • decreased oncotic pressure (hypoalbuminemia)
  • increased permeability (pneumoia)
  • impaired lymph drainage (malignancy)
  • movement of fluid into peritoneal space (ascites)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

define:
* pneumothorax
* hydrothorax
* hemothorax
* chylothorax
* pyothorax

A
  • pleural: abnormal accumulation of fluid in pleural space
  • hydro: noninflammatory collection of serous fluid
  • hemo: blood accumulation
  • chylo: lymph fluid
  • pyo: infection
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

transudative vs exudative effusion

A
  • transudative: increased hydrostatic/decreased oncotic pressure
  • exudative: increased vascular permeability (high protein)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

causes of transudative?

5

A
  • CHF
  • nephrotic syndrome
  • cirrhosis
  • hypoalbuminemia
  • atelectasis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

causes of exudative

A
  • malignancy
  • infection/empyema
  • trauma
  • TB
  • SLE
  • dressler syndrome
  • pancreatitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

first place fluid accumulates?

A

subpulmonic location

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

describe blunting of costophrenic angles w/ effusion

A
  • takes 300 mL of fluid to blunt when lateral
  • takes 75 mL of fluid to blunt the posterior costophrenic angle
  • pleural thickening from fibrosis can blunt costophrenic angles
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

why does mensicus sign happen?

A
  • natural elastic recoil of lungs so the pleural fluid appears to rise higher along lateral aspect of thorax
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

how does free flowing fluid look in following views:
* upright
* supine
* semi-recumbent
* decubitus

A
  • upright: base of thoracic cavity
  • supine: layer on post pleural space
  • semi rec: triangular density of varying thickness
  • decub: bandlike distribution along dependent side
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

why would you use decubitus views

A
  • confirm presence of pleural effusion
  • detemine if it is free flowing
  • “uncover” part of lung hidden by effusion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

components of complete opacification of hemithorax

A
  • takes 2L of fluid to opacity entirely
  • displacement of heart/trachea away from affected side
  • can cause atelectasis
  • difficult to evaluate lung w/ CXR, do CT
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Describe loculations

A
  • adhesions in pleural space (empyema/hemothorax)
  • not free flowing, will not change with position
  • more often require chest tubes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

describe pseudotumors

A
  • caused by heart failure
  • loculated fluid commonly located in minor fissure
  • lemon shaped
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Laminar Effusion

A
  • type of pleural effusion
  • fluid takes on a thin, band like density along lateral chest wall near costophrenic angle (usually will not blunt the angle)
  • CHF most common cause
17
Q

hydropneumothorax

A
  • presence of both air & fluid in thorax
  • causes: trauma, surgery, thoracentesis, bronchopleural fistula
  • loss of meniscoid shape (straight line)
18
Q

laterality causes:
* right
* leftt
* bilat
* nonspecific unilat

A
  • r: ascite, RA
  • l: pancreatitis, dressler syndrome
  • bilat: CHF, SLE
  • unilat, nonspecific: malignancy, TB, PE, pneumonia
19
Q

pleural effusion tx

A
  • underlying condition: diuretics, diet control
  • thoracentesis
  • chest tube (if empyema)
  • pleurodesis (recurrent)