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The Respiratory System > Pleural Effusion and Malignancy > Flashcards

Pleural Effusion and Malignancy Flashcards

1
Q

What are the two types of pleura?

A
  1. Visceral - surrounding lungs - forms interlobal fissures
  2. Parietal - attached to body wall - covers mediastinum, diaphragm and inner surface of the thorax
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2
Q

What is the space formed due to the inferior borders of the pleural being much lower than the lung bases?

A

Costodiaphragmatic recess

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3
Q

How much intrapleural fluid should there be and what is its function?

A

4ml

Allows for pleura to stick together slightly and slide smoothy over each other

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4
Q

How much intrpleural fluid is required to be visible ona CXR?

A

200ml

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5
Q

What is a pleural effusion?

A

An abnormal collection of fluid in the pleural space

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6
Q

Which tests are required when there is a pleural effusion?

A
  • CXR
  • Pleural aspiration - sample of fluid tests for transudate or exudate
  • Cytology tests
  • Culturing of fluid to test for presence of microbes
  • Contrast enhanced CT scan or pleural biopsy may be required
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7
Q

If the pleural fluid is straw coloured what can this mean?

A

Cardiac failure

Hypoalbuminaemia

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8
Q

If pleural fluid is bloody what can this suggest?

A

Trauma

Malignancy

Infection

Infarction

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9
Q

What can it signify if pleural fluid is milky/turbid?

A

Empyema

Chylothorax - accumulation of chyle - lymph from digestive system

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10
Q

When pleural fluid is foul smelling, what can this mean?

A

Anaerobic empyema present

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11
Q

If food particles are present in the pleural fluid what does this signify?

A

Ruptured oesophagus

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12
Q

If there is a bilateral pleural effusion what may be the cause?

A

LVF

Drugs

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13
Q

What is transudate fluid?

A

Low protein count (<30g/l)

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14
Q

What is exudate fluid?

A

High protein count (>30g/l)

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15
Q

Usually transudate fluid is associated with __________ conditions

A

Benign

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16
Q

What is the normal pH for pleural fluid?

A

7.6

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17
Q

At what pH will pleural fluid:

  1. Suggest inflammation
  2. Require draining due to high infection risk
A
  1. 7.3
  2. 7.2
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18
Q

If neutrophils are present in the extracted fluid from a pleural effusion what does this suggest?

A

The effusion is acute

19
Q

Why is it difficult to differentiate between neoplasia and hyperplasia during fluid cytology?

A

Both possess features such as increased RNA, large nuclei and chromatin clumping

Neoplastic cells, however are less uniform, and there is more variation in the size of thier nuclei and cytoplasm

20
Q

When suspecting pleural maligancy, what are the three options?

A
  1. Observe closely ofr future change
  2. Repeat tests - thoracentesis - no more than 2 samples
  3. Obtain tissue biopsy - percutaneous blind biopsy, CT guided or thoracoscopy
21
Q

Why do pleural biopsies often come back negative in the presence of a postive result?

A
  • Bad technique - no pleura obtained
  • Pleural disease is discontinuous
  • This effusion is not due to a malignancy, yet one is coincidentally present
22
Q

What are ancillary effusions?

A

Effusions as a result of another condition such as a tumour

23
Q

What is atelectasis?

A

Complete or partial collapse of a lung lobe often as a complication during surgery

24
Q

What is mesothelioma?

A

An uncommon malignant tumour found in the lung lining or potentially in the lining of the abdominal cavity

25
Q

What is the main cause of mesothelioma?

A

Asbestos exposure

26
Q

What are the symptoms someone with mesothelioma may experience?

A
  • Fever
  • Weight loss
  • Chest pain
  • Sweating
  • Cough
27
Q

How can mesothelioma be investigated?

A

Imaging - view pleural nodules, pleural circumferance increases, local invasions or lung entrapment

Pleural fluid aspiration - determines cytology

Biopsy

28
Q

Pleurodesis is a treatment for mesothelioma, what is it?

A

It is a treatment where the pleural layers are fused obliterating the pleural space

29
Q

What are some treatment options for mesothelioma?

A
  • Pleurodesis
  • Radiotherapy
  • Surgery
  • Chemotherapy
  • Palliative care
30
Q

What is talc pleurodesis?

A

Talc is added to the pleural space to induce inflammation and fibrosis which will prevent further effusions

31
Q

What is a long term solution for a patient to control thier pleural effusions?

A

The use of a pleural catheter

32
Q

What is a LENT score?

A

A scoring system used to estimate survival rates for malignany pleural effusions

L - LDH (lactate dehydrogenase) estimates tissue damage

E - ECOG performace score - patient’s ability to take care of themselves

N - neutrophil to lymphocyte ratio in serum

T - tumour type

33
Q

What is a pneumothorax?

A

The presence of air in the pleural space causing lung collapse

34
Q

What is a primary pneumothorax?

A

Occurs in normal lungs

Often as a result of apical bullae rupture

35
Q

What is a secondary pneumothorax?

A

Occurs as a result of an underlying lung disease such as COPD

36
Q

What are risk factors for pneumothorax?

A
  • Tall thin men
  • Smokers
  • Cannabis users
  • Other lung disease
37
Q

What are symptoms of pneumothorax?

A

Acute pleuritic chest pain

Hypoxia

38
Q

What are the signs of pneumothorax?

A

Tachycardia

Hyper-resonant percussion note

Reduced expansion

Quiet breath sounds

39
Q

What is a tension pneumothorax?

A

With each breath in, more air enters the pleural space, but the air cannot escape so only increases with time

Organs are pushed to the opposite side of the chest and acute respiratory distress may occur

40
Q

What are some signs of a tension pneumothorax?

A
  • Deviated trachea
  • Hypotension
  • Raised JVP
  • Reduced air entry on affected side
41
Q

How can a tension pneumothorax be treated?

A

Needle decompression

(second intercostal space mid-clavicular line)

42
Q

What two main things can a deviated trachea indicate?

A
  1. Fluid build up
  2. Lung collapse (including pneumothorax)
43
Q

On a CXR what does a line with a meniscus indicate?

A

A sub-diaphragmatic effusion - fluid below the lungs

44
Q

What does a straight line on a CXR indicate?

A

Lung collapse

The Respiratory System (16 decks)

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