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ICM -- Pulmonology > Pleural Effusion > Flashcards

Pleural Effusion Flashcards

1
Q

Normal amount of fluid in a pleural space?

A

5-25 ml

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2
Q

What is the pleural space?

A

a potential space/serous membrane between the thin visceral and parietal pleura

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3
Q

Normal movement of pleural fluid

A

Made by parietal pleura, absorbed by visceral pleura

Should eb virtually fluid free

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4
Q

Three basic ways to get a fluid into the pleural space

A

Increased drainage of fluid in
Increades production by cells in the space
Decreased drainage from the space

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5
Q

Defects that could alter the fluid homeostasis of the pleural cavity, causing effusion (8)

A

Increased Capillary hydro. pressure (CHF)
Increased capillary permeability (Pneumonia)
Increased intrapleural pressure (atelectasis)
Decreased plasma oncotic pressure (hypoalbuminemia)
Decreased pleural mem. permeab. (malignancy)
Increased lymphatic obstruction (malignancy)
Diaphragmatic Defect (hepatic hydrothorax)
Thoracic Duct Rupture (Chylothorax)

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6
Q

ID the fluid found in….

Hydrothorax, Hemothorax, Chylothorac, Empyema

A

Hydro - Serous
Hemo - Blood
Chylo – Milk-like (lymphatics)
Empyema - Pus

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7
Q

Causes of transudative pleural effusion?

A

CHF, Cirrhosis, Nephrotic Syndrome, Constrictive pericarditis, peritoneal dialysis

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8
Q

Causes of exudative pleural effusion?

A 
PARAPNEUMONIC + TB
Connective Tissue Disorders
Malignancy
Pancreatitis
Subphrenic Abscess
Dengue
Radiation Pleuritis
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9
Q

Causes of chylous pleural effusion?

A

Congenital
Post-traumatic
Post-malignancy

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10
Q

Causes of hemothorax

A

Blunt trauma

Malignancy

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11
Q

Top 4 most common causes of pleural effusion

A

CHF
Pneumonia
Cancer
PE

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12
Q

Physical exam findings associated with pleural effusion?

A 
Dullness to percussion
Decreased tactile fremitus
Asymmetric expansion
Decreased breath sounds
Egophony
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13
Q

How to diagnose pleural effusion?

A

CXR (Lateral decubitus most sensitive)
Pleural fluid analysis
Chest US
CT scan (fluid, abscess, or tumor)

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14
Q

Fluid in Xray is seen as…

A

Dense, White Shadow with a concave upper edge

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15
Q

How do heart/mediastinum move in response to atelectasis? effusion?

A

TOWARD ATELECTASIS

AWAY FROM HEMOTHORAX

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16
Q

Indications for thoracentesis?

A

Unilateral effusion, asymmetric bilateral
Evidence of pleurisy/fever
No response to diuresis in 2-3 days
Effusion out of proportion to clinical setting

17
Q

How is thoracentesis performed?

A

Needly passd through upper border of lower rib to remove 50-100 mL fluid for analysis.

18
Q

According to Light’s Criteria, how is a fluid labeled as Transudate?

A

Pleural fluid protein: Serum Protein ration under 0.5
Pleural LDH:serum LDH under 0.6
Pleural fluid LDH is less than 2/3 of serum level (or under 200)

19
Q

According to Light’s Criteria, how is a fluid labeled as Exudate?

A

Failure to meet any of the three criteria for transudate

20
Q

Pleural glucose levels below 3.3 mmol/L (or 1/2 serum glu) indicate…

A

RA Pleurisy, Empyema, Malignancy, Esophageal Rupture

Lupus, TB

21
Q

Low pH fluid indicates…

A

RA Pleurisy, Malignancy, Empyema, Esophageal Rupture

Urinothorax

22
Q

Significant elevation of lactate (over 90) strongly increased your index of suspicion for…

A

bacterial/TB pleural infections

23
Q

Elevated amylase levels (above 1.5-2) indicate the presence of…

A

pancreatitis
esophageal rupture
malignant effusion

24
Q

Elevated Adenosine deminase (over 43) indicates…

A

TB

25
Q

Elevated IFN-g (over 140 pg/ml) indicates…

A

TB

26
Q

Elevated eosinophil values (over 10%) may indicate…

A

Pneumothorax, Hemothorax, Parasitic/Fungal Infection

27
Q

Markedly increased numbers of mesothelial cells in bloody/eosinophilic effusions indicate…

A

PE

28
Q

Lung cancer most prone to cause effusion

A

Adenocarcinoma

29
Q

Most common cancer to cause effusion in young adults

A

Lymphoma

30
Q

What is a chylothorax ad what might cause itq

A

An acute effusion with a normal pleural surface with TG above 110. Its caused by trauma or malignancy.

31
Q

What is a pseudochylothorax and what might cause it?

A

Chronic effusion with a thickened pleura. Cholesterol over 200. Can be caused by any chronic effusion (over 6 months)
Typically associated with TB or RA

32
Q

Labs for pleural effusion patient that gets a chest tube (5 features)

A 
Complicated 
Fluid is cloudy, pH under 7.2, 
glucose under 40, 
LDH over 1000
PMN over 25,000
33
Q

Causes of chest tube decision

A

EMPYEMA
Complicated parapneumonic effusion
Hemothorax
Malignant efusion

34
Q

Three stages of Empyema

A

Exudative (1-3 days)
Fibrinopurulant (4-14)
Organizational (14+)

ICM -- Pulmonology (9 decks)

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