Take The Quiz To Learn About Pleural Effusion

To identify the cause of radiographic abnormalities, a healthcare professional might ask the patient about their travel history to determine if they have been exposed to any infectious diseases or environmental factors. They might also inquire about their occupational exposures to assess if their work environment could be contributing to the abnormalities. Additionally, the patient's smoking history is relevant as smoking can lead to certain lung conditions. Lastly, their past medical history is important to understand if there are any pre-existing conditions that could be causing the abnormalities. Therefore, asking the patient about all of these factors can help in identifying the cause of the radiographic abnormalities.

If a pleural effusion is greater than 1cm on decubitus x-ray, do a diagnostic thoracentesis. Using Light's criteria, you can determine whether the effusion is Exudative or Transudative. Exudative causes of pleural effusion are Pulmonary (infectious, neoplastic, inflammatory, PE, Chylothorax, Hemothorax) or GI (ruptured esophagus, pancreatitis). Transudative pleural effusions are caused by heart failure (systolic, diastolic, and valvular disease) or low protein states (nephrotic, cirrhosis).

pleural fluid to serum ratio of LDH: 2.4 (greater than 0.6 - exudate) pleural fluid to serum ratio of total protein: 0.6 (greater than 0.5, exudate) pleural fluid LDH 1.2x upper limit (235) 3/3 Light's Criteria consistent with exudative effusion

The patient should be advised to consider surgical pleurectomy and apical bullectomy, as this procedure can help in treating the condition if it happens again. VATS (Video-Assisted Thoracoscopic Surgery) is another option that can be considered for the treatment. Additionally, the patient should be instructed to avoid scuba diving and flying for at least 8 weeks to prevent any further complications. Therefore, all of the above options should be advised to the patient.

The given answer is correct because all of the other options are criteria included in Light's Criteria for the diagnosis of pleural exudative effusions. Light's Criteria includes pleural proteins/serum proteins greater than 0.5 ratio, pleural LDH/serum LDH greater than 0.6 ratio, and LDH greater than 2/3 upper limit of normal for serum. However, total proteins greater than 2/3 upper limit of normal for serum is not included in Light's Criteria.

The findings here are of a multi-loculated effusion with airspace disease and pleural enhancement, suggesting infectious/inflammatory etiology. Extensive airspace disease is seen on the lung windows of the CT scan. Importantly, air bronchograms are seen which suggests airspace disease, and also rules out significant endobronchial obstruction. No other lesions to suggest neoplasm or other etiology.

The given information suggests a diagnosis of pneumothorax. The patient's sudden onset of severe right chest pain, associated with severe shortness of breath and decreased breath sounds on the right chest, along with increased resonance on the right, are indicative of a collapsed lung. The absence of other symptoms such as cough, sputum, or infectious symptoms, as well as the patient's occupation and smoking history, further support the diagnosis of pneumothorax.

Affects all ages but more common in extremes of age; men > women. Incidence higher in those with diabetes, alcoholism or substance abuse, rheumatoid arthritis or chronic lung disease. Poor dentition and aspiration risk associated with increased prevalence.

Despite standard pleural fluid analysis 25% exudative effusions undiagnosed. Pleural fluid cytology alone only 40% sensitive but can increase to 80% with 3 samples
blind needle biopsy only 44% sensitive (many false negatives!. Thoracoscopy above 90% sensitive for malignancy and TB. The patient went on to thoracoscopy and biopsies of the parietal pleura revealed adenocarcinoma, with special pathology stains indicating that it was suspicious for a GI primary tumour. the cytology from the pleural fluid was sent at the time of thoracoscopy also revealed malignant cells consistent with adenocarcinoma. Colonoscopy then revealed a colon cancer as the primary.

pus is seen therefore, by definition, this is an empyema. Pleural fluid to serum ratio of LDH: 6.3, pleural fluid to serum ratio of total protein: 0.6, pleural fluid LDH 3.3x upper limit (235) - 3/3 Light's criteria consistent with exudative effusion (only one needed to determine exudate)

According to the diagnostic/therapeutic algorithm, the patient should be drained and a catheter left in place. He should be empirically treated with broad spectrum antibiotics awaiting microbiology results. These infections are often poly-microbial. Here you would ensure coverage for Strep. pneumonia based on the initial gram stain. He will require prolonged drainage and antibiotics (at least 6 weeks or until resolution). If he fails to improve he may be considered for surgical management.

Spontaneous pneumothorax is more commonly seen in young, tall, thin males, as they are more likely to have subpleural blebs and airway inflammation, which are risk factors for this condition. Smoking is also a risk factor for spontaneous pneumothorax. However, females are not typically predisposed to spontaneous pneumothorax, making it the exception among the given risk factors.

25-50%, usually within the first year. High risk individuals: females, tall stature, continue to smoke. If recurs, risk of future recurrences even higher.

There is a large left sided effusion with meniscus sign laterally. It is difficult to know how much of the opacity is underlygin airspace disease vs. effusion. A lateral and decubitus view would better delineate this. No mediastinal shift is seen.

there is no displacement of mediastinal structures.

This patient has NO evidence of tension pneumothorax on CXR and, more importantly, is hemodynamically stable, so therapy is not emergent. However he is in distress and hypoxemia, so needs to be treated ASAP.

14 gauge needle to 2nd intercostal space. Explanation: In treating a pneumothorax or a similar condition, the primary goal is to remove the trapped air in the pleural cavity and promote the re-expansion of the lung. Several methods can be used to achieve this, including observation for spontaneous resolution in small pneumothoraces, simple aspiration using a needle or catheter, and chest tube drainage (thoracostomy). However, the use of a 14 gauge needle specifically to the 2nd intercostal space is not a standard or recommended procedure for treating this problem. Generally, the 2nd intercostal space is not the preferred location for aspiration or chest tube insertion due to the risk of damaging the vital structures in the upper chest, such as the internal mammary artery or the subclavian vessels. Instead, in cases where aspiration or chest tube drainage is required, the procedure is usually performed at a lower intercostal space, such as the 4th, 5th, or 6th intercostal space in the mid-axillary or anterior axillary line. This helps minimize potential complications and ensures effective treatment of the problem.

insignificant: 1cm, normal glucose & pH >7.2, gram stain neg, complex parapnuemonic: >1cm, pH 1cm, pH