Pleural disease Flashcards
What is a pneumothorax?
(1. ) Air enters pleura cavity due to hole in lung or chest wall injury.
(2. ) Intrapleural pressure is negative so this will lead to air being sucked into the cavity.
(3. ) Leading to partial or total lung collapse
Types of pneumothorax
(1. ) Spontaneous
- Primary = Without a trigger event in an otherwise normal long
- Secondary = occurs in a lung with a pre-existing lung disease
(2. ) Traumatic/Iatrogenic
What is primary spontaneous pneumothorax and RF
(1. ) Primary = Without a trigger event in an otherwise normal long
(2. ) Rupture of apical pleural bleb
(3. ) RF = tall, thin, 20-40y male presenting with Sx at rest, smoking
What is a tension pneumothorax?
(1. ) This is a medical emergency + requires imaging and urgent decompression
(2. ) Most often due to a punctured lung, trauma, mechanical ventilation
(3. ) Injured pleura forms a ‘one-way valve’ i.e. air going into the cavity but not out, so with every breath the pneumothorax gets bigger.
(4. ) This displaces the mediastinum and cardiac compromise -> life threatening resp failure/cardiac arrest
- > inc pressure in chest, reduces amount of blood returned to heart.
Presentation of pneumothorax
- Asymptomatic
- Breathlessness
- Pleuritic Chest pain
Signs
- Tachypnoea
- Hypoxia
- Haemodynamic instability (tachycardia, hypotension)
- Reduced breath sounds
- Hyper-resonant percussion note
- Deviated trachea in tension
Ix of pneumothorax
(1. ) CXR - 1st line
- dark lungs indicates air (usually in apex)
- trachea deviation in tension PTX
- note: bullae is not a pneumothorax
(2. ) CT
- if there is a Dx uncertainty
- allows for measurement of size
How is the pneumothorax measured
- Can be done on CT or CXR
- Intrapleural distance (at the level of the hilum) is measured
- If >2cm this indicates a large pneumothorax
Management of pneumothorax
Primary S.P.
(1.) If <2cm + pt is well = no intervention, FU + safety net if breathlessness
(2.) If >2cm = pleural needle aspiration. If still symptomatic consider chest drain
Secondary S.P.
(1. ) Chest drain
(2. ) Surgery fo persistent or recurrent pneumothorax
Conservative
(1. ) Stop smoking
(2. ) No air flight until 6w after resolution
(3. ) No scuba diving
RF for pneumothorax re-occurence?
(1. ) Secondary SP
(2. ) Age
(3. ) Fibrosis
(4. ) Emphysema
Mx of Surgical emphysema
- This is NOT pneumothorax, as air is located in the subcutaneous tissue usually in chest, face or neck.
- Cut into subcutaneous tissue + push air out
- Air escapes under the tissue (crispy leaves)
- Most of the time it’s not an issue
What is a pleural effusion?
(1. ) This is fluid in the pleural space.
(2. ) Effusion can be divided by their protein concentration:
- transudates (low)
- exudates (high)
What causes transudates pleural effusion
(1. ) Low protein
(2. ) Increased hydrostatic pressure or reduced osmotic pressure in microvascular circulation
(3. ) Causes: HF, Cirrhosis, renal failure, hypoalbinaemia, myxoedema (thyroid failure), ascites, peritoneal dialysis
What causes exudates pleural effusion?
(1. ) High protein conc
(2. ) Increased capillary permeability and impaired reabsorption
(3. ) Causes: pneumonia, cancer, TB, AI - SLE, RA, PE, pancreatitis, drug induced
Clinical features of pleural effusions
Symptoms
- Asymptomatic
- Dyspnoea
- Pleuritic chest pain
- Cough
- Fever
Signs
- Reduced expansion
- Quiet breath sounds
- Stony dull percussion
- Reduce tactile/vocal fremitus
Investigations of pleural effusions
(1. ) CXR
- Small effusions = blunting at costophrenic angle
- Bigger effusions = ‘meniscus’ level inside diaphragm
(2.) Diagnostic Aspiration guided w/US.
