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Flashcards in Pleural Disease Deck (20):
1

How does LV heart failure lead to pleural disease?

It leads to a back flow into the lungs that can lead to pulmonary edema and/or pleural effusions

2

How does pulmonary HTN worsen pleural disease?

It results in back flow into the RV which will flow back into the IVC which worsens pleural effusion as it reduces the amount of fluid that is drained

3

What are some of the mechanism by which pleural effusion can occur?

- Leaky Membranes - inflammation
- Increased Capillary Hydrostatic Pressures - CHF
- Decreased Pleural Hydrostatic Pressure - atelectasis
- Decreased Capillary Oncotic Pressures - hypoalbuminemia

4

Pleural Effusion

Excessive fluid accumulation in the pleural space

5

What are some physical exam signs of pleural effusion?

􏰁- Dullness to Percussion
􏰁- Decreased Breath Sounds and Tactile Fremitus 􏰁
- Egophony

6

What are some CXR signs of pleural effusion?

􏰁“blunting of the angle” 􏰁
“meniscus”
􏰁“white-out”
“lateral decubitus” shows “layering”
"loculations"

7

What is the main tool for diagnosis of pleural effusions?

Thoracentesis

8

What type of effusion do they following cause:
- LV failure
- Cirrhosis,
- Malnutrition
- Atelectasis

Transudative

9

What type of effusion do the following cause:
- Infection
- Inflammation
- Cancer
- Direct entry of ascitic fluid blood, lymph, GI secretions

Exudative

10

What are the criteria for transudative VS exudative effusion?

- LDH(pl) > 200 (or 2/3 upper normal)
OR
􏰁- Cholesterol(pl) > 45

Either of these will confirm the effusion as exudative

11

What can cause LDL levels in the pleura to be falsely elevated and lead to a possible mis-diagnosis of an exudative effusion?

Diuresed HF can show falsely increased LDH due
to concentration as fluid back diffuses => this won’t
happen with cholesterol though

12

What are the top 4 causes of transudative effusions?

􏰁 CHF
􏰁 Cirrhosis
􏰁 Nephrotic Syndrome
􏰁 Atelectasis

13

What are the major causes of exudative effusions?

Cancer
Infections (Empyema)
Parapneumonic Effusions
Pulmonary Embolism

14

What drug can cause exudative effusions?

Hydralazine

15

What is the pH of pleural effusion normally around?

Higher than serum due to bicarbonate

16

When will low pleural effusion pH be seen?

Infection and esophageal rupture

17

Empyema

Infection in the pleural space

18

Pleurodesis

Chemical or mechanical irritation of the visceral and parietal pleura to create adhesion and obliteration of the pleural space - to prevent re-accumulation of fluid in the space

19

Tension Pneumothorax

Ball-Valve Mechanism - air enters the pleura during inspiration through a flap that closes during expiration, trapping ever more air/pressure in the pleural space that occurs after a pneumothorax occurs

20

What is found on physical exam of a pneumothorax?

-􏰀 Unilateral Hyperinflation
􏰀- Decreased Breath Sounds and Tactile Fremitus
-􏰀 Hyper-resonance

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