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Pleural Pathology

Pleurisy

Indicatres the involvement of pleura by any disease process producing

pleuritic pain or evidence of pleural friction

Pneumothorax

 A pneumothorax refers to a collection of gas in the pleural spaceresulting in collapse of the lung on the affected side.

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Causes of Pneumothorax

Traumatic Pneumothorax

Iatrogenic Pneumothorax e.g. thoracentesis or surgery Spontaneous Pneumothorax

Rupture of distended alveoli into Pleural cavity

Tuberculosis

Lung Abscess Bronchogenic Carcinoma

Pulmonary infarction

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Types of pneumothorax.

 Closed type.

 Open type.

 'Tension' (valvular) type.

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Tension Pneumothorax

Most dangerous where communication Between Lungs and Pleurapersists and act as a one way valve which allows air to enter thePleural space during inspiration and coughing but prevents it fromescaping.

Thus pressure within Pleural space rapidly increases causing severelife threatening collapse of Lungs and Mediastinal displacement

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Open Pneumothorax

In this form an abnormal Communication is made between bronchusand Pleural space. (bronchopleural fistula )

communication fails to seal and air continues to transfer freelybetween the lung and pleural space.

 Air pressure in Pleural space is equal to atmospheric pressure inboth phases of Respiration

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Closed Pneumothorax

The communication between Pleura and Lung seals off as the Lungdeflates and does not to reopen.

The air is gradually absorbed and Lung re-expands.

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Pleural Effusion

Pleural effusion is defined as an abnormal accumulation of fluid in thepleural space.

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The following mechanisms play a role in the formation of pleuraleffusion:

Increased capillary hydrostatic pressure in the systemic and/orpulmonary circulation (eg, congestive heart failure)

Increased capillary permeability or vascular disruption (eg,trauma, neoplastic disease, inflammatory process, infection,pulmonary infarction, drug hypersensitivity,)

Reduction in intravascular oncotic pressure (eg,hypoalbuminemia, hepatic cirrhosis)

Decreased lymphatic drainage or complete blockage, includingthoracic duct obstruction or rupture (eg, malignancy, trauma)

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The accumulation of serous fluid within the pleural space is termedpleural effusion.

 Accumulations of frank pus (empyema) or blood (haemothorax) r

Chyle (lymph)  – chylothorax

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Common Causes of Pleural Effusion*Transudative

CCF Cirrhosis of Liver

Nephrotic Syndrome

Constrictive pericarditis

Malnutrition

Meig's Syndrome

Malignant disease

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Common Causes of Pleural Effusion*Exudative

Pulmonary TB

Pneumonia

Bronchial Carcinoma

Pulmonary infarction

 Acute Pancreatitis

Liver Abscess Sub phrenic abscess

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Features Exudative  Transudative 

1. Occurrence Inflammatory condition Non inflammatory

condition

2. Cause Increased vascular permeability Increased HydrostaticPressure

3. Total Protein Content Same as plasma Less than in Plasma

4.Distribution of Protein As in Plasma Nearly all Albumin

5. Specific Gravity High Low6. Cells Plenty of Inflammatory Cells Few

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LIGHT'S CRITERIA FOR DISTINGUISHING PLEURALTRANSUDATE FROM EXUDATE

Pleural fluid is an exudate if one or more of the following

criteria are met:- Pleural fluid protein: serum protein ratio > 0.5

- Pleural fluid LDH: serum LDH ratio > 0.6

- Pleural fluid LDH > two-thirds of the upper limit of

normal serum LDH

(LDH = lactic dehydrogenase)

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Pleural tumours

Primary tumours

Fibroma /Solitary Fibrous Tumor /(Benign Mesothelioma)

Malignant mesothelioma (Asbestos may be the carcinogenicagent)

Secondary metastatic tumour

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Define & types of pneumothorax

Write down the causes of Pneumothorax

Define & write down the causes of pleuraleffusion

Transudate & exudate difference

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