Pleural Diseases: Treatment Overview

Study Notes

Thoracocentesis:
- Primarily indicated for pleural effusion
- Fluid is removed via needle insertion above the 10th rib at the scapular line
- Requires strict aseptic conditions
- Potential complications include hemothorax, pneumothorax, neurogenic shock, and pulmonary edema
Intercostal Chest Tube:
- Used for managing pneumothorax (open, bilateral, or tension), empyema, and hemothorax
Tension Pneumothorax:
- Medical emergency necessitating immediate decompression with a wide-bore needle in the 2nd intercostal space
- Followed by the insertion of an intercostal chest tube
- Includes management with oxygen and analgesics

Definition and Aetiology:
- Characterized by bronchial narrowing due to bronchospasm, inflammatory infiltrate (eosinophils), and mucus plugs
- Can be triggered by allergies (extrinsic) or bronchial hyper-reactivity (intrinsic)
Clinical Picture:
- Patients often asymptomatic between attacks
- Attacks typically occurring at night or early morning
- Symptoms include wheezing, non-productive cough, dyspnea, and production of viscous sputum post-attack
- Signs include restricted respiratory movement, palpable rhonchi, hyper-resonant percussion notes, and harsh vesicular breathing
Complications:
- Respiratory: Status asthmaticus (severe asthma) and respiratory failure
- General: Treatment complications like diabetes and hypertension from steroids
- Chronic Cough: May lead to myositis, rib fractures, pneumothorax, hemoptysis, puffy eyelids, and hernia
Investigations:
- Sputum examination reveals eosinophilia
- Blood tests show increased eosinophils and raised serum IgE in extrinsic asthma
- Skin prick tests help identify triggers
- Chest X-ray may show hyperinflation
- Pulmonary function tests often show obstructive hypoventilation
Treatment:
- Quick relief: Inhaled short-acting beta-2 agonists (SABA) like Salbutamol
- Control medications: Inhaled corticosteroids (ICS), long-acting beta-agonists (LABA), and leukotriene receptor antagonists
- For severe cases: oral or parenteral steroids and IgE monoclonal antibodies

Clinical Picture:
- Common symptoms include fever, anorexia, headache, malaise, cough, dyspnea, and rusty sputum expectoration
- Signs during examination include limited respiratory movement on the affected side, increased tactile vocal fremitus, dullness on percussion, and bronchial breathing with crepitations on auscultation
Special Types of Pneumonia:
- Staphylococcal Pneumonia: Caused by Staph. aureus; treated with nafcillin or vancomycin
- Friedlander's Pneumonia: Caused by Klebsiella in immunocompromised; apical lung involvement treated with ceftriaxone
- Pneumocystis Pneumonia: Caused by Pneumocystis jiroveci in AIDS patients; treated with Septrin or pentamidine
- Mycoplasma Pneumonia: Common in children and young adults; diagnosed by cold agglutination tests and treated with macrolides
- Legionella Pneumonia: Caused by Legionella pneumophila; associated with contaminated water; diagnosed via urine antigen test and treated with macrolides
Viral Pneumonia:
- Atypical pneumonia attributed to influenza viruses (including H1N1, H5N1), CMV, EBV, RSV, measles, and coronaviruses (SARS).