Pleural Effusions and Empyemas Chapeter 24, CHApter 27 ILD, CHAPTER 32 Sleep Apnea

Exudative Pleural Effusions

DDevelops when the pleural surfaces are diseased 

• Fluid has a high protein content 

• Has a great deal of cellular debris

• Usually caused by inflammation, infection, or malignancy

Transudative Pleural effucion

• Develops when fluid from the pulmonary capillaries moves into the pleural space

• Fluid is thin and watery

• Contains a few blood cells and little protein

• The pleural surfaces are not involved in producing the transudate

Anatomin Alterations

Treatment

Oxygen therapy protocol

• Lung expansion therapy protocol

• Mechanical ventilation protocol

• Pleurodesis 

Characteristics of other pathologic fluids

• Chylothorax

  • The presence of chyle in the pleural cavity 

  • Usually caused by trauma to the neck or thorax or by cancer occluding the thoracic duct 

Characteristics of other pathologic fluids

• Hemothorax

  • The presence of blood in the pleural space

Assesment findings Physical

• Vital signs

  • Increased 

    • Respiratory rate (tachypnea)

    • Heart rate (pulse)

    • Blood pressure

• Chest pain/decreased chest expansion

• Cyanosis

• Cough (dry, nonproductive)

Chest Xrays

• Chest radiograph

• Chest radi

  • Blunting of the costophrenic angle

  • Fluid level on the affected side

  • Depressed diaphragm

  • Mediastinal shift (possibly) to unaffected side

  • Atelectasis

  • Meniscus sign

Common Causes of Transudative Pleural Effusion

• Congestive heart failure is the most common cause 

• Hepatic hydrothorax

  • Patients with cirrhosis

  • Result of abdominal ascites  

• Peritoneal dialysis

  • When dialysis stopped, effusion usually disappears rapidly 

Common Causes of Transudative Pleural Effusion

• Parapneumonic pleural effusion

  • Effusions that occur as a result of underlying pulmonary infection 

• Nephrotic syndrome

  • Effusions generally bilateral 

  • A result of the decreased plasma oncotic pressure 

• Pulmonary embolism or infarction

  • 30%–50% of patients with pulmonary arterial emboli develop pleural effusion 

Common Causes of Exudative Pleural Effusion

• Malignant pleural effusions

• Malignant mesotheliomas

• Bacterial pneumonias

• Tuberculosis

• Fungal disease

• Pleural effusion resulting from diseases
  of the gastrointestinal tract

• Pleural effusion resulting from collagen vascular diseases

Anatomic Alterations OF ILD (INTERSTIAL LUNG DISEASE)

• Destruction of the alveoli and adjacent pulmonary capillaries

• Fibrotic thickening of the respiratory bronchioles, alveolar ducts, and alveoli

• Granulomas

• Honeycombing and cavity formation

• Fibrocalcific pleural plaques (particularly in asbestosis)

• Bronchospasm

• Excessive bronchial secretions (caused by inflammation of airways)

RISK FACTORS