Diseases of the Pleura

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🌱 來自: Huppert’s Notes

Diseases of the Pleura🚧 施工中

Diseases of the Pleura

•   Pleural Effusion:

-   Thoracentesis should be performed for new effusion to calculate Light’s criteria

-   Light’s criteria: Must have at least one to be considered exudative:

•   Pleural Protein/serum protein >0.5 (think P for Pentagon [five-sided])

•   Pleural LDH/serum LDH >0.6 (think H for Hexagon [six-sided])

•   LDH >2/3 upper limit of normal

•   Transudative: Increased hydrostatic pressure (CHF), decreased oncotic pressure (cirrhosis, nephrotic, other hypoalbuminemia). pH 7.4–7.55

•   Exudative: Increased permeability or decreased lymphatic drainage (infection, malignancy, connective tissue disease, CABG, PE). pH 7.3–7.45; <7.2 typical for empyema

-   Other useful features: High amylase (pancreatitis, malignancy), milky fluid (chylothorax, lymphatic), bloody fluid (malignancy; may need multiple thoracenteses to increase yield of cytology if malignancy expected), lymphocytic predominance and/or ADA elevation (TB)

•   Treatment:

-   Transudative: Diuretics, sodium restriction

-   Exudative: Treat underlying process. If complicated, involve pulmonology to discuss therapies like indwelling pleural catheters, chest tubes, etc. See Empyema in Infectious Diseases Chapter 8.

Pneumothorax

•   Spontaneous:

-   Primary: Typically occurs in tall lean men when a dilated alveolar bleb ruptures.

-   Secondary: Complication of lung disease, resulting in more severe symptoms

•   Traumatic: Iatrogenic (e.g., central line, thoracentesis – always check post-procedure CXR). Mediastinum shifts TOWARD pneumothorax.

•   Tension: Accumulation of air with one-way valve collapses ipsilateral lung and mediastinum shifts AWAY from the pneumothorax. Causes: Mechanical ventilation, CPR, trauma. Medical emergency! Perform immediate needle thoracostomy (large-bore needle; fifth intercostal space, mid-axillary), followed by chest tube placement.