pleural effusion
- related: Pulmonology, chest tube
- tags: #literature
Pathophysiology
- pleural effusion pathophysiology
- heart failure patients more likely to have right sided pleural effusion
- Meig syndrome can have pleural effusion
- pleural thickening on CT can indicate chronic inflammation or malignancy
- triangle of safety for thoracentesis
Fluid analysis
- light criteria for pleural effusion includes protein and LDH
- transudative vs exudative pleural fluid causes
- diuretic use will cause exudative effusion in heart failure patients
- pleural fluid with very high LDH and low glucose are found in either empyema or rheumatoid pleurisy
- triglyceride over 110 in pleural fluid suggests chylothorax
- lymphocyte predominant pleural fluid suggests lymphoma or TB
- eosinophilia in pleural effusion suggests BAPE, air, PE, or cancer
- elevated amylase in pleural effusion suggests esophageal rupture or pancreatitis
- pleural effusion in TB are exudative, lymphocyte predominant, have low glucose, and elevated adenosine deaminase
- chylothorax is elevated TG with low cholesterol
- complex effusion means septation on ultrasound
- hemothorax is when fluid hematocrit is over half of serum hematocrit
- LDH is higher in pleurodesis patients\
- use radioisotope scan to diagnose hepatic hydrothorax
- urinothorax is associated with obstructive uropathy after trauma or surgery
Parapneumonic effusion and Empyema
- simple effusion, uncomplicated, complicated parapneumonic effusion, empyema
- antibiotic duration for parapneumonic effusions
- spontaneous bacterial empyema SBEM is empyema without pneumonia
Thoracentesis and chest tube
- indications for diagnostic and therapeutic thoracentesis
- when to place chest tube for pleural effusion
- timing and frequency of tpa
- give intrapleural tpa when chest tube drainage is smaller than expected with residual fluid on imaging
- chest tube can be removed when drainage is less than 120 cc in 24 hours and pleural effusion is small on imaging
- complex fluid on US does not equal to loculation on CT
- measuring pleural elastance to determine lung entrapment
- trapped lung physiology is result of chronic lung entrapment
- removing small or large amount of pleural effusion have the same risk of reexpansion pulmonary edema
Malignant pleural effusion
- malignant pleural effusion are exudative, lymphocyte predominant, and often bloody
- 3 separate thoracentesis can detect up to 90 percent malignant effusions
- chemical pleurodesis for patients with longer expected survival or faster recurrent pleural effusion
- use TPA and not dornase for malignant pleural effusion
- avoid tpa in malignant pleural effusion with increased bleeding risks
- pleurx catheter results in fewer pleural procedure than talc pleurodesis
Post op pleural effusion
Literature notes
- Concurrent Intrapleural Instillation of Tissue Plasminogen Activator and DNase for Pleural Infection
- case conference PGY1 timing of TPA dornase
- relative CI:
- overlying infection
- 1 lung
- increased PEEP
- severe lung disease
- INR > 2.5, PTT > 2.5x normal
- Increased risks of bleeding
- Not as much with low platelet
- increased BUN or creatinine > 6 are high risks for bleeding
- intercostal artery: closer to ribs more lateral you are, usually good > 6cm from spine
Links to this note
- Pulmonology
- pleural effusion in TB are exudative, lymphocyte predominant, have low glucose, and elevated adenosine deaminase
- related: pleural effusion, Tuberculosis
- chest tube
- related: Pulmonology, pleural effusion
- simple effusion, uncomplicated, complicated parapneumonic effusion, empyema
- related: pleural effusion
- chylothorax is elevated TG with low cholesterol
- related: pleural effusion
- complex fluid on US does not equal to loculation on CT
- related: pleural effusion
- transudative vs exudative pleural fluid causes
- diuretic use will cause exudative effusion in heart failure patients
- related: pleural effusion
- pleural thickening on CT can indicate chronic inflammation or malignancy
- related: pleural effusion
- light criteria for pleural effusion includes protein and LDH
- related: pleural effusion
- pleural fluid with very high LDH and low glucose are found in either empyema or rheumatoid pleurisy
- related: pleural effusion, rheumatoid arthritis
- 3 separate thoracentesis can detect up to 90 percent malignant effusions
- related: pleural effusion
- antibiotic duration for parapneumonic effusions
- related: pleural effusion
- avoid tpa in malignant pleural effusion with increased bleeding risks
- related: pleural effusion
- case conference PGY1 timing of TPA dornase
- related: pleural effusion
- chemical pleurodesis for patients with longer expected survival or faster recurrent pleural effusion
- related: pleural effusion
- complex effusion means septation on ultrasound
- related: pleural effusion
- Concurrent Intrapleural Instillation of Tissue Plasminogen Activator and DNase for Pleural Infection
- related: pleural effusion
- eosinophilia in pleural effusion suggests BAPE, air, PE, or cancer
- related: pleural effusion
- hemothorax is when fluid hematocrit is over half of serum hematocrit
- related: pleural effusion
- indications for diagnostic and therapeutic thoracentesis
- related: pleural effusion
- lymphocyte predominant pleural fluid suggests lymphoma or TB
- related: pleural effusion
- malignant pleural effusion are exudative, lymphocyte predominant, and often bloody
- related: pleural effusion
- pleural effusion pathophysiology
- related: pleural effusion
- pleurx catheter results in fewer pleural procedure than talc pleurodesis
- related: pleural effusion
- post op pleural effusion can happen in CABG patients
- related: pleural effusion
- removing small or large amount of pleural effusion have the same risk of reexpansion pulmonary edema
- related: pleural effusion
- spontaneous bacterial empyema SBEM is empyema without pneumonia
- related: pleural effusion
- timing and frequency of tpa
- related: pleural effusion
- trapped lung physiology is result of chronic lung entrapment
- related: pleural effusion
- triangle of safety for thoracentesis
- related: pleural effusion
- triglyceride over 110 in pleural fluid suggests chylothorax
- related: pleural effusion
- urinothorax is associated with obstructive uropathy after trauma or surgery
- related: pleural effusion
- use radioisotope scan to diagnose hepatic hydrothorax
- related: pleural effusion
- use TPA and not dornase for malignant pleural effusion
- related: pleural effusion
- when to place chest tube for pleural effusion
- related: pleural effusion
- rheumatoid effusions have elevated cholesterol, high LDH, low glucose
- related: pleural effusion