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17 Cards in this Set
- Front
- Back
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229. Pleural fluid pearls:
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229. Pleural fluid pearls:
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230. Elevated pleural fluid amylase, think (3)?
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1. Esophageal rupture
2. Pancreatitis 3. Malignancy |
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231. Milky, opalescent pleural fluid; think?
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1. Chylothorax (lymph in pleural space)!
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232. Frankly purulent pleural fluid, think?
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1. Empyema!!!!!!!
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233. Bloody effusion pleural fluid, think?
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a. Malignancy
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234. Exudative pleural effusions are primarily lymphocytic, think?
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a. TB!
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235. Pleural effusion pH <7.2, think?
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a. Parapneumonic effusion !!!!!!
b. or c. Empyema |
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236. Treatment of transudative pleural effusions?
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a. Diuretics and sodium restriction
b. Therapeutic thoracentesis- only if massive effusion is causing dyspnea. |
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237. Treatment of exudative pleural effusion?
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a. Treat underlying disease
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238. Treatment of uncomplicated parapneumonic effusions (pleural effusion in presence of pneumonia)?
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a. Antibiotics alone (in most cases)
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239. Treatment of complicated parapneumonic effusions (pleural effusion in presence of pneumonia) or empyema?
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a. Chest tube drainage
b. Intrapleural injections of thrombolytic agents (streptokinase or urokinase); may accelerate the drainage c. Surgical lysis of adhesions may be required. |
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240. Note: a parapneumonic effusion is a noninfected pleural effusion secondary bacterial pneumonia. In empyema is a complicated parapneumonic effusion, which means pleural effusion is infected.
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240. Note: a parapneumonic effusion is a noninfected pleural effusion secondary bacterial pneumonia. In empyema is a complicated parapneumonic effusion, which means pleural effusion is infected.
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241. Pleural fluid glucose is < 60, what should be ruled out?!?
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a. Rheumatoid arthritis
b. However, glucose in pleural fluid can be low with other causes of pleural effusion: 1. TB 2. Oesophageal rupture 3. Malignancy 4. Lupus |
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242. Causes of empyema?
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a. Exudative pleural effusions, if left untreated, can lead to empyema (plus within the pleural space)
b. Most cases occur as a complication of bacterial pneumonia, but other foci of infection can also spread to the pleural space (e.g, mediastinitis, abcess) |
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243. Clinical features of empyema?
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a. The clinical features are those of the underlying disease (pneumonia is most common).
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244. Diagnosis of empyema?
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a. CXR and CT of the chest are recommended tests
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245. Treatment of empyema?
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a. Treat with aggressive drainage of the pleura (via thoracentesis ) and antibiotic therapy
b. Infection is very difficult to eradicate, and recurrence is common, requiring repeated drainage. c. If empyema is severe and persistent, rib resection and open drainage may be necessary. |
