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57 Cards in this Set

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Lungs are derived from ____ but pleura are derived from _____/
endoderm, mesoderm
Tightly adherent to lung.
Visceral pleura
Lines chest wall.
Parietal pleura
Pleura allow lungs to do what?
move independently in the chest
If pleural space scars, are lungs still fxnal?
yes, unless scarring is so severe to trap lung and prevent m'ment
T/F: Pleura are critical for life.
False
What advantage does the pleural space give to thoracic surgeons?
you can reinflate a collapsed lung
What is the consistency of pleura?
like vinyl on a backpack
T/F: Pleura is difficult to see radiographically in the absence of disease.
True
Pleural plaque is ____ pleura.
thickened
Histological appearance of pleura.
Layer of mesothelial layer, followed by a layer of collagen and elastic fibers w/ blood vessels
2-12 microns in diameter, allow fluid that has been filtered in pleural space to escape to lymphatics
stomata
Stomata are only found in the ___ pleura.
parietal
Visceral pleura is supplied by ____ arteries, drains into ____ veins.
bronchial, pumlmonary
Parietal pleura is fed by ____ arteries, drains into ___.
intercostal, systemic circulation
Average pressure of pleural space?
-5 cm H2O
Normally turnover rate of transudate is ___ ml/day, this is the same amount that is normally in there.
20
Abnormal accumulationof fluid (>100-200 ml) in pleural space.
pleural effusion
Mechanisms of pleural effusion.
altered starling forces - high hydrostatic or low oncotic pressures
increased capillary permeability - inflammation
reduced elimination - lymphatic obstruction w/ cancer
entry from somewhere else - diaphragm
How does fluid enter pleural space from diaphragm?
diaphragm has openings that act like one way valves. Ascitic fluid in peritoneum gets into pleural space b/c of lower pressure
Definition of transudate:
All three criteria:
pleural fluid/serum protein ratio < 0.5
pleral fluid/serum LDH < 0.6
pleural fluid LDH < 2/3 upper limit of normal for serum LDH
Definition of exudate:
Failure to meet one of the following criteria:
pleural fluid/serum protein ratio < 0.5
pleral fluid/serum LDH < 0.6
pleural fluid LDH < 2/3 upper limit of normal for serum LDH
Tap effusion using needle through chest wall
thoracentesis
3 common causes of transudate:
CHF (most common) - increased hydrostatic pressures
nephrotic syndrome - low blood protein
cirrhosis - low protein, also get ascites
High pulomary circulation causes ___ ___ and ___ pleural effusion.
pulmonary edema, visceral
High pressure in systemic circulation causes _____ ____ and ___ pleural effusion.
peripheral edema, parietal
Pleural effusion tends to be ___ but is worse on ___.
bilateral, right
Four common causes of exudate:
pneumonia
cancer
pulmonary thromboemboli
collagen vascular disease
Parapneumonic effusions can get infected b/c of all the bacteria and white cells in exudate...this is called?
empyema
What is the cut off for tapping a parapneumonic effusion?
more than 1 cm of fluid on lateral decubitis film
Most common causes of malignant effusions?
LC and breast cancer
What defines a LC (stage 3b) that is not resectable?
cancer cells in pleural fluid
How does cancer cause an exudative effusion?
blocking the lymphatics and disrupting the capillaries
Why does PE result in a exudative effusion?
infarction at level of embolus so there's damaged tissue and inflammation -->leaky capillaries
An effusion due to PE often contains what?
blood
Two common collagen vascular diseases that can give effusions.
RA and lupus
Which collagen vascular disease has the highest prevalence of pleural effusion?
RA
Low glucose in an exudative effusion indicates?
empyema or RA
High amylase in an exudative effusion indicates?
pancreatitis or esophageal perforation
Lymphocytes in an exudative effusion indicates?
TB
Blood in an exudative effusion indicates?
3T's:
Tumor
Trauma
Thromboemboli
What determines the difference between bloody effusion and hemothorax?
hematocrit>50% of peripheral blood hematocrit indicates hemothorax that must be drained
High triglycerides in exudative effusion indicates?
chylothorax, due to thoracic duct being interuppted by lymphoma
Air in the chest.
Pneumothorax
Tall young men are susceptible to ____ pneumothoracies. Why?
spontaneous

Lung is long and has a lot of weight, putting traction on top of lung. This causes subpleural bullae which ruptures, giving a pneumothorax and deflating lung.
Patient has one spontaneous pneumothorax. Your course of action?
With a second?
Put in chest tube and let air leak out.

After second one, scar chest wall by abrading parietal pleural to prevent another.
What can cause bullous changes leading to possible pneumothorax?
How do these patients tolerate this?
emphysema

Don't tolerate it well b/c of underlying disease... you should scar chest wall after first occurence.
Hole in lung acts as a one way valve that pulls air into chest, but air can't get out. With each breath pneumothorax gets bigger and bigger.
Tension pneumothorax
Tension means that pressure is greater in pleural space/atmosphere?
pleural space
What can a tension pneumothorax lead to?
one lung shifts past midline and impedes fxn of other lung and impedes venous return to chest
Most common cause of pleural plaque.
asbestos exposure
T/F: A patient w/ pleural plaques is more likely to get mesothelioma than another patient (who is also exposed to asbestos).
False
Lay term for pleural pain?
Which means?
pleurisy/pleuritic pain
inspiratory pain
Does pleuritic pain always come from pleura?
No, can break a rib and have inspiratory pain w/o pleural involvement. Pericarditis can also cause inspiratory pain.
When someone complains of pleuritic pain check for?
pneumonia
If someone complains of pleuritic pain, but has clear CXR and no fever, you should check for?
pulmonary thromboemboli
You can see pleural pain from a ____ infection that usually gives an ____
viral, effusion