Pleural Disease Flashcards
(26 cards)
What are the SYMPTOMS of PLEURAL EFFUSION?
1) Asymptomatic - if small and slow to accumulate
2) > Dyspnoea
3) Pleuritic Chest Pain
4) Dry Cough
5) Fever
6) Malaise
7) Weight Loss
8) Night Sweats
What are the MAIN SIGNS of PLEURAL EFFUSION?
1) < Chest Expansion (Affected Side)
2) Stony Dullness to Percussion
3) Bronchial Breathing
4) < Vocal Resonance
What are the MAIN CAUSES of PLEURAL EFFUSION?
Transudates
Exudates
What is a TRANSUDATE?
An Imbalance of Hydrostatic Forces Influencing the Formation and Absorption of Pleural Fluid
Normal Capillary Permeability
Can be Bilateral
What is an EXUDATE?
> Permeability of Pleural Surface and or Local Capillaries
Usually Unilateral
Following pleural aspiration, what is the cut-off measurement for pleural protein in a TRANSUDATE?
< 30 g/l
Following pleural aspiration, what is the cut-off measurement for pleural protein in an EXUDATE?
> 30 g/l
What are the COMMON CAUSES of a TRANSUDATE PLEURAL EFFUSION?
Left Ventricular Failure
Liver Cirrhosis
Hypoalbuminaemia
Peritoneal Dialysis
What are the COMMON CAUSES of an EXUDATE PLEURAL EFFUSION?
Malignancy, i.e. Breast Cancer, Mesothelioma or Metastases
What INVESTIGATIONS would be used to diagnose a PLEURAL EFFUSION?
1) CXR - 200ml of Fluid must be Present to be Detectable
2) CT Thorax - Differentiates between Malignant and Benign Disease
3) Pleural Aspiration
4) Pleural Biopsy - at Least 4
5) FBC and Serum Biochemistry
6) Video Assisted Thoracoscopy, if necessary
What CRITERIA would be used to differentiate a TRANSUDATE from an EXUDATE?
Light’s Criteria
How would a pleural effusion be MANAGED?
Treatment Aimed at the Cause, i.e. Chemo (Malignancy) or Anti-TB Chemo (TB)
Palliative Care (Malignancy)
Pleurodesis - Obliteration of the Pleural Space; Adhesion of the Pleurae with Talc
Where on the thorax would a CHEST DRAIN be INSERTED for the purposes of PLEURODESIS?
4th Intercostal Space, Mid-Axillary Line
What are the SYMPTOMS of a PNEUMOTHORAX?
Acute Dyspnoea and/or Worsening Dyspnoea
Pleuritic Chest Pain
What are the SYMPTOMS of a TENSION PNEUMOTHORAX?
Extreme Dyspnoea
Diaphoretic
What are the SIGNS of a PNEUMOTHORAX?
Can be Negligible Signs
Tracheal Shift TOWARDS the Affected Side
< Expansion
Hyper Resonance
Absent/ < Breath Sounds
What are the SIGNS of a TENSION PNEUMOTHORAX?
Tracheal Shift AWAY from the Affected Side
Raised JVP
Haemodynamic Compromise
How would a PNEUMOTHORAX be MANAGED?
Intercostal Chest Drain
CXR
Surgical Pleurodesis, if Required
Pleurectomy, if Required
Where would a CHEST DRAIN be INSERTED to treat a TENSION PNEUMOTHORAX?
2nd Intercostal Space, Mid-Clavicular Line
Describe the TYPES of PNEUMOTHORAX:
1) Spontaneous:
Primary - Idiopathic
Secondary - Complication of Other Lung Disease
2) Traumatic:
Non-Iatrogenic - Penetrating and Blunt Chest Injury
Iatrogenic - Medical Negligence
What is MESOTHELIOMA?
Pleural Malignancy, Largely, due to Asbestos Exposure
What are the SYMPTOMS of MESOTHELIOMA?
Dyspnoea
Pleuritic Chest Pain
What is a SIGN of MESOTHELIOMA?
Weight Loss - Due to Malignancy
How can MESOTHELIOMA be INVESTIGATED?
CXR
CT Thorax
Pleural Aspiration and Biopsy
