4.Pleural Pathology
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Transcript of 4.Pleural Pathology
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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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