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<< Click here to get 40 Pulmonology questions straight from my book The Final Step >>
Pleural effusion
- Excess fluid accumulation in the pleural cavity which limits breathing by limiting the ability of the lungs to expand.
- Serous fluid
- Blood
- Pus
- Urine?
Clinical Presentation
- Dyspnea
- Cough
- Chest pain
Labs, Studies and Physical Exam Findings
- Bronchial breath sounds
- Egophony (on auscultation an E sounds like an A)
- Dullness to percussion
- Diminished breath sounds
- Fremitus
- Pleural friction rub
- Chest x-ray – a white area of the lung
- CT can show smaller effusions
- Pleural biopsy
- U/S guided thoracentesis
- Exudative fluid (pleura is damaged and capillaries leaking)
- Pneumonia
- Malignancy
- Pulmonary Embolism
- Transudative fluid (reabsorption of fluid is decreased)
- Congestive heart failure
- Cirrhosis
- Exudative fluid (pleura is damaged and capillaries leaking)
Treatment
- Antibiotics if appropriate
- Therapeutic thoracentesis
- Chest tube placement
- Pleurodesis – obliteration of the pleural space
Pneumothorax & Tension Pneumothorax
- A pneumothorax is air or gas in the pleural space which will limit the lungs ability to expand.
- Pnuemothorax is often called a collapsed lung
- A tension pneumothorax is when a one way valve is created between lung and the pleural space. The valve allows air to enter the pleural space on inspiration but does not allow it to escape during exhalation. With each inspiration the volume of air in the pleural space goes up.
Causes
- Primary pneumothorax no underlying lung disease
- Smoking is a risk factor
- Test questions often describe a young, tall thin male. They may use a male basketball player as the patient.
- Secondary pneumothorax is a complication of underlying lung disease
- COPD, asthma, cystic fibrosis, TB etc
- Traumatic pneumothorax
- Secondary to trauma either sharp or blunt
- Tension pneumothorax is usually caused by a traumatic event
Clinical Presentation
- Acute chest pain
- Acute shortness of breath
Labs, Studies and Physical Exam Findings
- Tachycardia
- Diminished breath sounds
- Hyperresonance to percussion
- Decreased fremitus
- Chest X-ray
- A visceral pleural line on an expiratory film is diagnostic
- Pleural air may be seen
- Contralateral mediastinal shift in a tension pneumothorax
Treatment
- A small primary pneumothorax may be watched and will likely resolve on its own. This is between 10 and 15% of the hemithorax involved
- Chest tube is the definitive therapy for a larger pneumothorax or a tension pneumothorax
- Pleurodesis
<< Click here to get 40 Pulmonology questions straight from my book The Final Step >>
