Notes in Pleural & Pericardial Diseases

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Status	Last Update	Fields
Published	10/19/2023	Pleural anatomy*two layers...parietal pleura- supplied by {{c1::systemic}} circulation- adjacent to chest wall, diaphragm, mediastinum (and cervical/t…
Published	10/19/2023	Pleural fluid- originates from {{c2::systemic}} vessels... plasma leaks out into {{c3::pleural space}} - reabsorbed by {{c1::lymphatics}} in parietal …
Published	10/19/2023	Pleural effusion- amount of pleural fluid that enters the pleural space > amount that can be removed by {{c1::lymphatics}}→ typically 0.01 ml/kg/hr…
Published	10/19/2023	Causes of pleural effusion- #1 cause: {{c1::CHF}} - #2 cause: {{c2::parapneumonic}} effusion (bacterial pneumoniae → fluid leaks into pleural spa…
Published	10/19/2023	History and Physical Examination of Pleural EffusionSymptoms- {{c1::SOB}}- {{c1::cough}}- {{c2::pleuritic}} chest pain (think inflammation)Signs- decr…
Published	10/19/2023	Radiology of pleural effusionCXR- lower lung field homogeneous density that forms a concave {{c7::meniscus}} → blunted {{c8::costophrenic angle}}…
Published	10/19/2023	Thoracentesis*procedure that involves removing pleural {{c2::fluid}} trans-thoracically- can be {{c3::diagnostic}} (to find etiology of effusion) and …
Published	10/19/2023	re-{{c7::expansion}} pulmonary edema- process: pleural effusion is present → {{c8::thoracentesis}} is preformed to drain fluid in pleural cavity → lun…
Published	10/19/2023	Pleural Fluid Analysis- Cell count and differential (look for WBC, neutrophils to check for infection or for lymphocytes) - pH  - {{c2:…
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Published	10/19/2023	Light's criteria- based on values of protein and LDH levels in pleural fluid:serum- only need to match one of the boxes to be considered {{c1::ex…
Published	10/19/2023	Causes of {{c1::transudative}} effusion■ {{c3::Congestive heart failure (CHF)}} ■ {{c5::Cirrhosis}} ■ {{c4::Nephrotic}} syndrome ■ Hypo{{c4:…
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Published	10/19/2023	- if {{c1::transudative}} effusion, no further pleural studies necessary, just treat {{c2::underlying cause}}- if {{c1::exudative}} effusion, get cell…
Published	10/19/2023	Color of pleural effusion gives a clue- straw → {{c4::transudative}}- bloody → {{c3::hemothorax / malignancy}} - cloudy → {{c2::bacterial infection}} …
Published	10/19/2023	Complicated para-pneumonic effusion- effusion associated with pulmonary {{c4::infection}} that does not resolve without intervention- indications for …
Published	10/19/2023	low {{c1::glucose}} levels in {{c2::exudative}} pleural effusion is a result of highly metabolic cancer
Published	10/19/2023	CASE: A 72-year-old male with PMHX of 80-pack year history of smoking presents with progressive dyspnea on exertion and a chronic productive cough. Up…
Published	10/19/2023	Pleurisy- infection / {{c1::inflammation}} / irritation of {{c3::parietal}} pleura → loss of smooth {{c2::sliding}} movement …
Published	10/19/2023	management of pleurisy- treat underlying cause because {{c1::inflammation}} resolves when primary disease process resolves→ if viral – {{c2::supp…
Published	10/19/2023	{{c1::pneumothorax}} is air in pleural space → collapsed lung *no lung {{c2::markings}}/vasculature and dark black color on CXR
Published	10/19/2023	classification of pneumothorax- can be {{c1::spontaneous}}→ {{c3::primary}} {{c1::spontaneous}}: no underlying {{c2::lung}} disease, patients typ…
Published	10/19/2023	Clinical Symptoms & Signs of Pneumothorax- {{c3::dyspnea}}: shortness of breath- cough - {{c1::pleuritic}} chest pain - increased {{c4::pressures}…
Published	10/19/2023	{{c6::Primary}} spontaneous pneumothorax (PSP)- “{{c1::idiopathic}}” pneumothorax but believed to be due to apical, subpleural {{c2::bleb}} that …
Published	10/19/2023	{{c2::Secondary}} spontaneous pneumothorax (PSP)- most common with underlying {{c1::COPD}} (aberrant lung structure → emphysema)*other (inte…
Published	10/19/2023	Treatment of Pneumothorax- if small, non-enlarging pneumothorax → {{c2::observe}}*supplemental 100% oxygen to washout nitrogen from alveoli - if large…
Published	10/19/2023	Tension pneumothorax- severe increase in {{c7::intrathoracic}} pressure- recognized clinically with {{c1::hypotension}} and {{c1::tachycardia}} and so…
Published	10/19/2023	Acute pericarditis- inflammation of {{c6::pericardial}} tissue that is most often {{c5::idopathic}} (80% of the time) but can also be due to {{c7::vir…
Published	10/19/2023	Cardiac tamponade- can be a complication of pericardial {{c3::effusion}} → increased pressure outside → impaired diastolic {{c1::filling}} of the hear…
Published	10/19/2023	*{{c7::pulsus paradoxus}}: decrease in SBP > 10 mmHg during inspiration
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Published	10/19/2023	{{c2::Echocardiogram}} is the most helpful type of cardiac imaging when tamponade is suspected*shows hemodynamic parameters best
Published	10/19/2023	cardiac tamponade{{c1::pericardiocentesis}} guided with ultrasound is the best treatment for cardiac tamponade{{c2::diuretics}} are NOT recommend…
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