PneumothoraxDefinition 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 EffusionDefinition 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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