Pleural Diseases Flashcards Preview

Term 5 - PathoPhysio > Pleural Diseases > Flashcards

Flashcards in Pleural Diseases Deck (12):
1

  • PLEURAL EFFUSION
  • Signs:

  • Decreased or absent tactile fremitus
  • Dullness to percussion & shifting dullness (pathognomonic)
  • Diminished breath sounds over the area of effusion
  • Bronchial breath sounds and egophony can often be heard just above the effusion due to presence of atelecatatic lung

2

  • Pleural Fluid: Transudate
  • Causes

  • CHF
  • Cirrhosis
  • Nephrotic syndrome
  • Myxedema

3

  • Pleural Fluid: Exudate
  • Causes

  • Neoplastic disease
  • Infectious Diseases
  • Pulmonary Emboli
  • Pancreatitis
  • Collagen Vascular diseases

Exudate if:

  • Protein ratio of Pleural fl/serum > 0.5 and LDH ratio of pleural fl/serum > 0.6

4

  • Malignant Pleural Effusions
    • Mechanism of effusion:

Combined effect of increased pleural permeability, Obstruction of pleural lymphatics, Thoracic duct interruption (chylous) and Hypoproteinemia

5

TUBERCULOUS PLEURITIS: diagnosis

  • If pleural fluid adenosine deaminase (ADA) >70 units
  • If pleural fluid gamma interferon is high
  • Granulomas on pleural biopsy
  • Lymphocytic effusion.

6

Diagnostic value of pleural fluid analysis: HIGH AMYLASE

  • Acute pancreatic disease
  • Chronic pancreatic disease
  • Esophageal rupture (fluid may contain food particles in addition)
  • Malignant pleural effusion

7

  • CHYLOTHORAX 
    • Diagnosis:

  • Presence of chyle in the pleural space secondary to leakage from the thoracic duct or its tributaries.
  • Diagnosis:
    • Rapid accumulation of fluid in pleural space
    • Pleural fluid is turbid post centrifugation
    • Measure triglycerides and cholesterol in serum and pleural fluid. Chylothorax exists if:
      • Triglycerides >110 mg/dl and
      • Pleural fluid/serum triglyceride >1.0
      • Pleural fluid/serum cholesterol

8

PARAPNEUMONIC EFFUSION

  • Any pleural effusion associated with infectious pneumonia, lung abscess, or bronchiectasis
  • 40% of pneumonias are associated effusion
  • Character of the fluid varies from translucent, straw-colored fluid to frank pus

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9

  • Spontaneous pneumothorax
  • Risk factors for primary:

  • Smoking, tall, thin stature, Marfan syndrome, Pregnancy, Familial pneumothorax

Mechanism: associated with the presence of symptomatic blebs

10

  • Spontaneous pneumothorax
  • Risk factors for secondary:

  • COPD, Asthma, TB, Sarcoidosis, Cystic fibrosis, PCP pneumonia

Mechanism: Alveolar destruction associate with increased pulmonary pressure due to coughing

11

  • Spontaneous pneumothorax
  • Physical exam (signs)

  • Tactile fremitus is diminished or absent on the affected side
  • Hyper-resonance on the affected side on percussion
  • Diminished or absent breath sounds on affected side on auscultation
  • Shift of the mediastinum to the opposite side (in case of tension pneumothorax)

12

MALIGNANT MESOTHELIOMA

  • Associated with asbestos exposure (60%)
  • Distant metastases are rare
  • Tumors usually contain epithelial and mesenchymal cells and frequently large amounts of fibrous tissue
  • Most patients present with chest pain or dyspnea
  • Mostly accompanied with a unilateral exudative or hemorrhagic pleural effusion
  • Mediastinal lymph nodes may be involved • Difficult to distinguish it from metastatic adenocarcinoma

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