Pleural Disease Flashcards
(27 cards)
define pneumothorax
an abnormal collection of air within the pleural space that causes deflation of the lung
describe the types of pneumothorax
primary - no underlying lung pathology
secondary - underlying lung pathology
traumatic - occurs due to trauma penetrating injury
tension - large volume of air present within pleural space
risk factors of pneumothorax
smoking PMH of pneumothorax male sex - esp in fit, taller and thin young men chronic lung disease connective tissue disease
clinical features of pneumothorax
sudden pleuritic chest pain
dyspnoea
risk factors
signs of pneumothorax
tachycardia +tachypnoea cyanosis absent breath sounds on affected side hyper-resonsant percussion note on affected side reduced chest expansion
signs of tension pneumothorax
tracheal deviation
tachycardia
hypotension
investigations of pneumothorax
CXR
ABG
US (emergency/acute setting)
CT scan (if no evidence in CXR or suspicious)
management of tension pneumothorax
use ABCDE algorithm high flow (15L/min) O2 via non-rebreather mask immediate needle decompression using 16-gauge cannula at 2nd intercostal space, midclavicular line
management of primary pneumothorax
if not SOB and <2cm:
- observe 4-6hrs, discharge and advise to avoid strenuous exercise and seek medical attention if symptoms return
- re-evaluate with CXR at 2wks
if SOB OR >2cm:
- provide supplemental O2
- aspirate with 16-18G cannula under local anaesthetic
- if fails, intercostal drain and admission required
management of secondary pneumothorax
if not SOB and <1cm:
- admit for 24hrs observation and provide supplementary O2
if SOB OR 1-2cm:
- aspirate and adit + observe for 24hrs
- if not successful, chest drain required
if SOB OR >2cm:
- require intercostal drain
when is surgical intervention considered in those with pneumothorax?
if episodes of pneumothorax have been recurrent or air leak persists >48hrs
what surgical procedures are utilised in complicated pneumothorax cases?
open thoracotomy
pleurectomy
define pleural effusion
an abnormal build up of fluid in the pleural cavity
describe the two types of pleural effusion
exudative - inflammation causes leaking of protein into pleural cavity and a high protein count (>30g/L)
transudative - fluid moves across into pleural cavity, resulting in low protein count (<30g/L)
causes of exudative pleural effusion
due to increased permeability of pleural surfaces/capillaries
e.g. lung cancer, TB, pneumonia, rheumatoid arthritis or trauma
causes of transudative pleural effusion
due to imbalance in starling forces that govern interstitial fluid
e.g. congestive cardiac failure, cirrhosis, chronic kidney disease and coeliacs
risk factors of pleural effusion
congestive heart failure pneumonia malignancy smoking PMH of chronic disease, lung infections or immunological disease
clinical features of pleural effusion
dyspnoea (esp on exertion)
cough
pleuritic chest pain
bronchial breathing
signs of pleural effusion
respiratory distress and tachypnoea reduced chest expansion stony dull percussion reduced/absent breath sounds reduced/absent vocal resonance
investigations of pleural effusion
1st line = CXR
US guided thoracentesis for pleural fluid
bloods:
- FBC, U+E, CRP, TFTs, LDH, serum amylase and tumour markers
- RF and autoimmune profile
common appearances of pleural effusion in CXR
blunting of costophrenic angle
white-out of a hemifield
contraindications of a pleural fluid sample
heart failure signs
- raised JVP
- pitting ankle oedema
- CXR signs
analysis of pleural fluid if protein 25-35g/L
effusion exudate if:
fluid to serum protein ratio > 0.5
pleural fluid to serum LDH >0.6
pleural fluid LDH >2/3 of upper limit of serum LDH
additional parameters of pleural fluid analysis
glucose - ⬇️ in RA, TB or malignancy
pH - <7.2 in empyema
amylase - ⬆️ in pancreatitis
