Pleural diseases Flashcards
(27 cards)
What is the pleura?
A serous membrane that folds back on itself to form a two layered membranous sac that surrounds the lungs
What is the name of the two layers?
Inner layer = Visceral
Outer layer = Parietal
How far above the lungs does the pleura project?
3cm above the clavicle
When doing a chest drain where should you stick the needle? Why?
Just above the rib, because just below the rib is where the nerves and blood vessels are
What does the pleura do?
Protects the lung
Allows friction-free movement of the lung against chest wall
Not really that vital in humans
How much fluid is there usually in the pleural cavity?
A tiny amount
What is in the pleural fluid?
Protein: mainly albumin
A few cells
List some pleural diseases
Pleural effusion Pleural thickening Pleural plaques Pleural malignancy Pleurisy
What is pleural effusion?
Fluid in the pleural space
What type of fluids can cause a pleural effusion?
What criteria is used?
Transudates: protein poor fluid
Exudates: protein rich fluid
(Light’s criteria)
Haemothorax: blood
Empyema: pus
Chylothorax: chyle (lymph + fat)
Haemopneumothorax: blood and air
What causes a transudate pleural effusion?
Heart failure Liver failure Renal failure Thyroid failure Nutritional failure (low protein from diet)
What causes an exudate pleural effusion?
Increased leakiness of pleural capillaries secondary to infection, inflammation or malignancy
So proteins leave capillaries and enter pleural cavity
What are the symptoms of a pleural effusion?
Asymptomatic
Pleuritic chest pain
SOB
What are the signs of a pleural effusion?
Reduced chest wall movement
Dull to percussion
Absent breath sounds
Reduced vocal resonance
Investigation of pleural effusion.
X-ray: cloudy
Diagnostic pleural fluid aspiration: take a sample and see what is in the fluid
Pleural biopsy
CT
When does a pleural effusion become visible on an X-ray?
When there is more than 500mL of fluid present
Management of a pleural effusion?
Exudate: drain
Transudate: treat underlying cause
What happens after you drain a pleural effusion caused by a malignancy?
How can you solve this problem?
It usually re-accumulates
Aspirate to dryness and then install a sclerosing (drying) agent such as talc, tetracycline
What is DPT?
Diffuse pleural thickening
A lung disease in which extensive scarring thickens the pleura, the thin membrane that covers the lungs.
As the scar tissue grows, it can encase the lung and close off the space between the lungs and pleura.
What causes DPT?
Asbestos exposure mainly
Infection
Trauma
Lupus
Many more
Can you treat DPT?
No, not really
What complications can from DPT?
Malignant mesothelioma
What is the most important type of pleural malignancy?
Malignant mesothelioma
What is pleurisy?
Inflammation of the pleurae, which impairs their lubricating function and causes pain when breathing.
