Pneumothorax
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Definition The accumulation of air in the pleural space
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Etiology spontaneous (primary pneumothorax), traumatic, or iatrogenic
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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
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Clinical features Acute onset ipsilateral chest pain and dyspnea, hyper resonance, diminished breath sounds, mediastinal shift to contralateral side (with tension PTX)
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Treatment--severely symptomatic/large PTX Chest tube
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Treatment--Tension PTX *Medical emergency. Large bore needle insertion then chest tube following decompression
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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
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Pleural Effusion
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Definition The accumulation of significant volumes of pleural fluid (25% from malignancy)
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1.Exudates "Leaky capillaries" (infix, malignancy, trauma)
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2.Transudates "Intact capillaries", associated with increased hydrostatic or decreased oncotic pressures (CHF, atelectasis, renal disease, liver disease/cirrhosis)
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3.Empyema Infection within the pleural space
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4.Hemothorax Bleeding into the pleural space (trauma, malignancy)
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Clinical features Dyspnea, dull-to-flat percussion over area of fluid, mediastinum shifted away from side of large effusion (often asymptomatic though)
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Gold standard diagnostic Thoracentesis: fluid sent for protein, LDH, pH, WBC w/ diff, glucose, cytology, Gram stain w/ culture/sensitivity
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Criteria to determine transudate vs. exudate Light's Criteria (fluid is exudate if any apply)
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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 |
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Exudative |
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