Pleural disease

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Author:
Mat
ID:
99356
Filename:
Pleural disease
Updated:
2011-09-01 13:20:05
Tags:
Rheum2
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Description:
Pleural disease
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  1. What are transudative pleural effusions?
    Transudative pleural effusions have a pleural fluid total protein/serum total protein ratio of 0.50 or less and a pleural fluid/upper limit of normal serum lactate dehydrogenase ratio of less than 0.67.
  2. What are exudative pleural effusions?
    Exudative pleural effusions have either a pleural fluid total protein/serum total protein ratio of more than 0.50 or a pleural fluid lactate dehydrogenase concentration greater than 0.67 of the upper limits of the normal serum concentration.
  3. What are the differential diagnosis for an exudative fluid with Pleural fluid lymphocytosis (at least 80% lymphocytes)?
    • narrows the differential diagnosis of the exudate to: tuberculous effusion
    • chylothorax
    • lymphoma
    • yellow nail syndrome
    • rheumatoid
    • pleurisy
    • coronary artery bypass graft surgery
    • sarcoidosis
    • acute lung rejection
    • uremic pleurisy
  4. What is the differential diagnosis for exudative fluid with pleual fluid less than 7.30?
    Pleural fluid pH less than 7.30 narrows the differential diagnosis of the exudate to complicated parapneumonic effusion, esophageal rupture, chronic rheumatoid pleurisy, malignancy, lupus pleuritis, and tuberculous effusion.
  5. What is the differential diagnosis if there is an increased pleural fluid amylase concentration?
    An increased pleural fluid amylase concentration (pleural fluid/serum amylase ratio greater than 1.0) limits the differential diagnosis to pancreatic disease (acute pancreatitis or pancreaticopleural fistula), esophageal rupture, and malignancy, most commonly adenocarcinoma of the lung.
  6. What is your intervention for a pt with a (+) PPD and a lymphocyte predominant exudative pleural effusion?
    Patients with a positive tuberculin skin test and a lymphocyte-predominant, exudative pleural effusion without an alternative diagnosis should be treated for pulmonary tuberculosis
  7. How do you treat spontaneous pneumothorax?
    Treatment of spontaneous pneumothorax depends on its size and whether underlying lung disease is present. An approach to management stratifies small (less than 2 cm) and large (2 cm or more) pneumothoraces between the lung and chest wall. A 2-cm pneumothorax approximates half the volume of the hemithorax. Simple aspiration is less likely to succeed in secondary spontaneous pneumothorax and is only recommended as an initial treatment of pneumothoraces less than 2 cm in minimally breathless patients younger than 50 years. Patients with primary spontaneous pneumothoraces that resolve with aspiration may be discharged, but hospitalization is recommended for patients with secondary spontaneous pneumothoraces. Small chest tubes are as effective as large ones, and small tubes should initially be used. Suction is not initially indicated because of the risk of re-expansion pulmonary edema and can be added after 48 hours if the pneumothorax persists. Initial tube thoracostomy, preferably with a small-bore catheter, is appropriate for secondary pneumothoraces more than 2 cm, particularly in patients older than 50 years.
  8. When is simple aspiration recommended in the treatment of pneumothorax?
    only recommended as an initial treatment of pneumothoraces less than 2 cm in minimally breathless patients younger than 50 years.
  9. For pleurodesis after an episode of pneumothorax, which one reduces the risk of recurrence?
    Pleurodesis via tube thoracostomy reduces the risk of recurrence to about 25%, whereas thoracoscopy reduces the risk to about 5%.

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