Pulmonology
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Definition
The accumulation of air in the pleural space
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Etiology
spontaneous (primary pneumothorax), traumatic, or iatrogenic
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Tension PTX
Secondary to a sucking chest wound or pulmonary laceration that allows air to enter the chest with inspiration but does't allow air to leave on expiration
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Clinical features
Acute onset ipsilateral chest pain and dyspnea, hyper resonance, diminished breath sounds, mediastinal shift to contralateral side (with tension PTX)
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Treatment--severely symptomatic/large PTX
Chest tube
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Treatment--Tension PTX
*Medical emergency. Large bore needle insertion then chest tube following decompression
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Definition
The accumulation of significant volumes of pleural fluid (25% from malignancy)
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1.Exudates
"Leaky capillaries" (infix, malignancy, trauma)
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2.Transudates
"Intact capillaries", associated with increased hydrostatic or decreased oncotic pressures (CHF, atelectasis, renal disease, liver disease/cirrhosis)
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3.Empyema
Infection within the pleural space
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4.Hemothorax
Bleeding into the pleural space (trauma, malignancy)
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Clinical features
Dyspnea, dull-to-flat percussion over area of fluid, mediastinum shifted away from side of large effusion (often asymptomatic though)
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Gold standard diagnostic
Thoracentesis: fluid sent for protein, LDH, pH, WBC w/ diff, glucose, cytology, Gram stain w/ culture/sensitivity
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Criteria to determine transudate vs. exudate
Light's Criteria (fluid is exudate if any apply)
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1) Pleural fluid protein to serum protein ration
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>0.5
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Exudative
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2) Pleural fluid LDH to serum LDH
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>0.6
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Exudative
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3) Pleural fluid LDH > upper 2/3 of normal serum LDH
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Exudative
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