Flashcards in Pleural Diseases Deck (57):
Describe the normal physiology of the pleural space
- fluid enters from capillaries in the visceral pleura
- fluid absorbed via lymphatics in the parietal pleura
Define pleural effusion
- abnormal build up of fluid in the pleural space
What can cause a pleural effusion?
- pleural fluid formation > absorption
- rate of absorption is decreased
- transport of peritoneal fluid from the abdominal cavity through the diaphragm or via lymphatics from a subdiaphragmatic process
Describe the physiology of pleural effusion and the result of each
- increased production of fluid in normal capillaries (abnormal pressure changes) ==> low protein "transudates"
- increased production of fluid d/t abnormal capillary permeability/inflam ==> high-protein "exudates"
- decreased lymphatic clearance ==> high protein "exudates"
- infection in pleural space
- bleeding into the pleural space
- lymphatic leakage from the thoracic duct or one of the main lymphatic vessels that drains into it
What are the types of pleural effusions?
When do transudative type pleural effusion occur?
- altered systemic factors
- absence of local pleural disease
- leakage of fluid from intact normal capillaries d/t increased hydrostatic or decreased oncotic pressures
What are the causes of pleural effusion?
- MC: CHF
- nephrotic syndrome
When do exudative pleural effusions occur?
- altered local factors
- presence of pleural disease
- increased production by the capillaries or blocking of lymphatics
- impaired lymphatic drainage/leaky capillaries
What are the causes of exudative pleural effusions?
- MC: parpneumonic effusion
- 2nd MC: 2ndary to malignancy
- 2ndary to viral infection
What are the 3 types of parapneumonic pleural effusions?
What causes hemothorax?
- MC: trauma
- ruptured blood vessel
What is diagnostic of hemothorax?
- pleural fluid hematocrit:peripheral blood hematocrit > 0.5
What causes chylothorax?
- MC: lymphoma & surgical trauma
What does the cylothorax fluid look like?
- milky, white
What are the symptoms of pleural effusion?
- pleuritic chest pain
What are the signs of pleural effusion?
- decreased unilateral chest movement on affected side
- decreased breath sounds over area
- dull to percussion
- decreased tactile fremitus
- pleural friction rub
- tracheal deviation to contalateral side if large
What does a pleural friction rub indicate?
What diagnostic tests are ordered for pleural effusion?
What amount of fluid is required to see pleural effusion
- 75-100mL on lateral view
- 175-200mL on AP/PA view
How is a lateral decubitus CXR view helpful for pleural effusion?
- identifies free flowing vs. loculated effusions
What is the treatment of pleural effusion?
- tx underlying dz
What would purulent fluid from a thoracenteis point towards?
What would putrid odor from a thoracenteis point towards?
- anaerobic empyema
What would milky, white fluid from a thoracenteis point towards?
What would blood from a thoracenteis point towards?
What is the traditional method to ddx between exudative and trasudative pleural effusions?
- Lights Criteria
What would the Lights Criteria yield in exudative pleural effusion?
- meets at least 1 criteria
What would the Lights Criteria yield in transudative pleural effusion?
- meets no criteria
What is the treatment for malignant effusion?
- serial thoracentesis if recurs
What is the treatment for empyemas?
- long term abx
What is the treatment for hemothorax?
- immediate large bore chest tube placement
What is the definition of pleuritis/pleurisy?
- pain d/t acute pleural inflam caused by iritation of the parietal pleura
What causes pleuritis/pleurisy?
- anything that causes inflam
What are S&S of pleuritis/pleurisy?
- sharp, localized chest pain
- worsened by sneezing, deep breathing, or movement
What is the treatment for pleuritis/pleurisy?
- tx underlying dz
- pain control
- collection of gas/air in the pleural space ==> collapsed lung
What are the types of Ptx?
- primary spontaneous
- secondary spontaneous
What causes a primary spontaneous Ptx?
- absence of underlying lung dz
What causes a secondary spontaneous Ptx?
- presence of underlying lung dz
What causes a traumatic Ptx?
- penetrating or blunt trauma
- open wound
What causes iatrogenic Ptx?
- s/p procedures
What causes tension Ptx?
- lung infections
- mechanical ventilation
- resucitative efforts
What patient population is at highest risk for primary spontaneous Ptx?
- tall, thin, males 10-30 y/o
What is the suspected etiology of primary spontaneous Ptx?
- rupture of a subpleural apical bleb
For _______ Ptx, air pressure in the _______ _______ exceeds _______ pressure throughout the respiratory cycle
- pleural space
What happen to the internal chest organs in tension Ptx?
- pushed to contralateral side
What are two events that occur with tension Ptx?
- CV system collapse
What are the S&S of all types of Ptxs?
- chest pain on affected side
- acute epigastric pain
What is seen on PE for Ptx?
- respiratory distress
- unilateral chest expansion
- decreased breath sounds on affected side
- decreased tactile fremitus
Which of the common PE findings for Ptx suggest tension Ptx?
- mediastinal/trachial shift
What tests should be ordered for Ptx?
What will be seen on CXR for Ptx?
- ipsilateral lung edge/visceral pleural line parallel to chest wall
- increased lucency
- deep sulcus sign
What is the tx for Ptx?
- small ( observation
- supplemental O2 to increase rate of reabsorption
- chest tube
- immediate decompression for tension