Pleural Disease

Question 1

What are some common causes of pneumothorax?

Answer 1

• Spontaneous
• Trauma
• COPD
• Bullae rupture
• Marfan’s

Question 2

What are some general symptoms/signs of pleural pathology?

Answer 2

• Symptoms
  
  • Pleurisy (PE, infection, malignancy, pneumothorax)
  • SOB
  • Cough
• Signs
  
  • Decreased breath sounds
  • Dull percussion note (fluid) or increase (air)
  • Decreased chest expansion
  • Laterality
    
    • Bilateral - CCF, low serum protein, sympathetic
    • Unilateral - infection, malignancy, inflammatory (post-PE also)

Question 3

What are the management prinicples of a patient with a pneumothorax?

Answer 3

• Conservative - pain relief, O2 (absorbed faster than normal air, can decrease pneumothorax more quickly)
• Chest drain - direct to apex of lung (try for axillary rather than anterior)
• Surgery (severe) - pleurodesis