Cheatography
https://cheatography.com
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This is a draft cheat sheet. It is a work in progress and is not finished yet.
What are the pleura
Two layers of tissue surrounding lungs |
• Visceral pleura – attached to lung.
• Parietal pleura – attached to chest wall |
between layers |
Pleural space/cavity |
Pleural lined by |
mesothelial cells |
Secrete |
small amount pleural fluid for lubrication |
Pneumothorax
Defenition |
Air in pleural space |
Two types to know about |
• Spontaneous
• Tension |
Spontaneous PTX
Primary |
●Rupture of subpleural bleb
●Common in tall, thin young males |
Secondary |
●Older patients with underlying pulmonary disease
● COPD |
Manifestation |
◇ sudden onset dyspnea
◇Sometimes pleuritic chest pain(when you take a deep breath) |
Diagnosis |
CXR |
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|
Pneumothorax treatment
100% oxygen |
◇Displaces nitrogen from capillary blood
◇↑gradient for nitrogen reabsorption from pleural space |
Chest tube |
Larger pneumothoraces (>15% lung volume) |
Tension PTX
Usually from trauma |
Air enters pleural space but cannot leave |
Medical emergency |
Emergent thoracentesis/chest tube placement |
Trachea deviates AWAY from affected side |
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Pleural effusion
Accumulation of fluid in pleural effusion
Etiologies of pleural effusion
Transudative |
Exudative |
Lymphatic |
Transudative effusion
Defenition |
Something driving fluid into pleural space |
Most common cause |
CHF (high pressure) |
Other causes |
●Nephrotic syndrome
(low protein)
● Cirrhosis
(low albumin) |
Treatment |
Underlying cause (no driange) |
Exudative effusion
Defenition |
Fluid leaking into pleural space
•High vascular permeability |
Many causes |
◇ malignancy
◇ pneumonia
◇ More protein in pleural fluid vs. transudative |
Treatment |
Usually requires drainage |
Transudate vs. Exudate
Thoracentesis |
to obtain fluid sample |
Test for |
protein, LDH |
Light’s Criteria – Exudate if: |
• Pleural protein/serum protein greater than 0.5
Pleural LDH/serum LDH greater than 0.6
Pleural LDH greater than 2/3 upper limits normal LDH |
Lymphatic Effusions“Chylothorax”
• Lymphatic fluid effusion
• From thoracic duct obstruction/injury
• Malignancy most common cause
• Trauma (usually surgical)
• Milky-appearing fluid
• Very high triglycerides
◇TG usually > 110 mg/dL |
Other Effusions
Hemothorax |
High Hct in fluid |
Empyema |
Infected pleural fluid
Pus, putrid odor, positive culture |
Malignant effusion |
Positive cytology |
Mesothelioma
Defenition |
Pleural tumor |
only known risk factor |
Asbestos
--->Decades after exposure |
Imaging |
Pleural thickening and pleural effusion |
Slow onset symptoms |
dyspnea, cough, chest pain |
Poor prognosis |
•Median survival 4 to 13 months untreated
• 6 to 18 months treated with chemo |
Asbestos For those who work in shipyards
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