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Pleural Effusion & Pneumothorax

Terms in this set (26)

Exudative pleural effusion causes:
bacterial pneumonia
malignancy
viral infection
pulmonary embolism
Most common symptom of pleural effusion
pleuritic chest pain & dyspnea
Clinical manifestations of pleural effusion include:
•Dependent on specific cause
•Pleuritic chest pain (most common)
•Dyspnea on exertion
•Fever (if infectious related)
•Dullness to percussion
•Diminished breath sounds
•Pleural friction rub
Transudative pleural effusion occurs when:
systemic factors that influence the formation and absorption of pleural fluid are altered
Transudative pleural effusion causes:
CHF (LV failure)
nephrotic sx
cirrhosis
Exudative pleural effusion occurs when:
local factors that influence the formation and absorption of pleural fluid are altered
Thoracentesis findings diagnostic of exudative pleural effusion
1.Pleural fluid protein/serum protein >0.5
2.Pleural fluid LDH/serum LDH >0.6
3.Pleural fluid LDH more than two-thirds the normal upper limit for serum
Further diagnostic procedure for exudative pleural effusion
-Measure PF glucose
-Obtain PF cytology
-Obtain differential cell count
-Culture, stain PF
-PF marker for TB
Exudative PF glucose < 60 considerations:
-malignancy
-bacterial infections
-rheumatoid pleuritis
If "further diagnostic procedures" for exudative pleural effusion are not diagnostic, what do you check next?
Consider PE (spiral CT or lung scan): Yes? ---> treat PE
If "further diagnostic procedures" for exudative pleural effusion are not diagnostic & pt negative PE, what do you check then?
PF marker for TB: Yes?---> treat for TB
If pleural effusion symptoms not improving and complete workup unrevealing, what do you do next?
Consider thoracoscopy of image-guided pleural biopsy
The most common cause for pleural effusion
Heart failure
When is diagnostic thoracentesis appropriate for PE a/w heart failure?
1. if the effusions are not bilateral and comparable in size
2.if the patient is febrile
3.if the patient has pleuritic chest pain to verify that the patient has a transudative effusion.
4.If the effusion persists despite therapy
•Pro-brain natriuretic peptide (NT-proBNP)>_____ pg/ml- effusion is secondary to congestive heart failure
>1500
Hepatic hydrothorax is usually ___________?
Right-sided
Parapneumonic effusions are associated with ______?
infectious etiology (bacterial pneumonia, lung abscess, or bronchiectasis)
Most common cause of exudative pleural effusion
Parapneumonic effusion
Parapneumonic effusion should be consider when
a patient presents with bacterial pneumonia
If the free fluid separates the lung from the chest wall by _______, a therapeutic thoracentesis should be performed
>10mm
Parapneumonic effusion clinical factors indicating the need for more invasive procedure include:
1. Loculated pleural fluid
2. Pleural fluid pH <7.20
3 .Pleural fluid glucose <3.3 mmol/L (<60 mg/dL)
4. Positive Gram stain or culture of the pleural fluid
5. Presence of gross pus in the pleural space
Uncomplicated parapneumonic effusions
Free-flowing sterile exudates of modest size that resolve quickly with antibiotic treatment of pneumonia (do not need drainage)
Empyema
Gross infection of the pleural space indicated by positive Gram stain or culture
Complicated parapneumonic effusions
Present the most difficult management decisions. They tend to be larger than simple parapneumonic effusions and to show more evidence of inflammatory stimuli, such as low glucose level, low pH, or evidence of loculation
Second most common type of exudative pleural effusion
Malignant pleural effusions secondary to metastatic disease
Pnuemothorax signs and symptoms
•Acute onset of unilateral chest pain and dyspnea
•Unilateral chest expansion
•Decreased tactile fremitus
•Hyperresonance
•Diminished breath sounds,
•Mediastinal shift
•Cyanosis and hypotension
•Pleural air on chest radiograph
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