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Pulm II: Pleural Diseases Cheat Sheet by



The accumu­lation of air in the pleural space
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

The accumu­lation of signif­icant volumes of pleural fluid (25% from malign­ancy)
"­Leaky capill­ari­es" (infix, malign­ancy, trauma)
"­Intact capill­ari­es", associated with increased hydros­tatic or decreased oncotic pressures (CHF, atelec­tasis, renal disease, liver diseas­e/c­irr­hosis)
Infection within the pleural space
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
2) Pleural fluid LDH to serum LDH
3) Pleural fluid LDH > upper 2/3 of normal serum LDH

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