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Pulm II: Pleural Diseases Cheat Sheet by

Pulmonology

Pneumo­thorax

Definition
The accumu­lation of air in the pleural space
Etiology
sponta­neous (primary pneumo­tho­rax), traumatic, or iatrogenic
Tension PTX
Secondary to a sucking chest wound or pulmonary laceration that allows air to enter the chest with inspir­ation but does't allow air to leave on expiration
Clinical features
Acute onset ipsila­teral chest pain and dyspnea, hyper resonance, diminished breath sounds, medias­tinal shift to contra­lateral side (with tension PTX)
Treatm­ent­--s­everely sympto­mat­ic/­large PTX
Chest tube
Treatm­ent­--T­ension PTX
*Medical emergency. Large bore needle insertion then chest tube following decomp­ression
Tension PTX Buzzwords: Stab wound to chest. Hypote­nsion, tracheal shift
Sponta­neous PTX Buzzwords: Tall, skinny, male, band student, acute onset one-sided chest pain, dyspnea
 

Pleural Effusion

Defi­nit­ion
The accumu­lation of signif­icant volumes of pleural fluid (25% from malign­ancy)
1.Exudates
"­Leaky capill­ari­es" (infix, malign­ancy, trauma)
2.Tran­sudates
"­Intact capill­ari­es", associated with increased hydros­tatic or decreased oncotic pressures (CHF, atelec­tasis, renal disease, liver diseas­e/c­irr­hosis)
3.Empyema
Infection within the pleural space
4.Hemo­thorax
Bleeding into the pleural space (trauma, malign­ancy)
Clinical features
Dyspnea, dull-t­o-flat percussion over area of fluid, medias­tinum shifted away from side of large effusion (often asympt­omatic though)
Gold standard diagno­stic
Thorac­ent­esis: fluid sent for protein, LDH, pH, WBC w/ diff, glucose, cytology, Gram stain w/ cultur­e/s­ens­itivity
Criteria to determine transudate vs. exudate
Light's Criteria (fluid is exudate if any apply)

Light's Criteria (cont'd)

1) Pleural fluid protein to serum protein ration
>0.5
Exudative
2) Pleural fluid LDH to serum LDH
>0.6
Exudative
3) Pleural fluid LDH > upper 2/3 of normal serum LDH
 
Exudative
               

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