Disease of the pleura done by mohamad jaber

Disease of the pleura done by : mohamad jaber & abdallah al jazzazi

Diseases of the Pleura : 1)Plueral effusion 2)Empyema 3)mesothelioma 4)Pneumothorax 5)Tension pneumothorax

1)plueral effusion Definition Causes Classification of fluid

1)Pleural effusion: **Definition : excess fluid that accumulates in the pleural cavity, the fluidfilled space that surrounds the lungs **causes : 1) cardiopulmonary disorders , which causes : increased drainage of fluid into pleural space 2)systemic or localized inflammatory conditions , which causes: increased production of fluid by cells in the pleural space 3) Decreased drainage of fluid from the pleural space , (tb, lymphoma ) 4)Malignancy (mesothelioma )

**Classification of fluid accumulation : 1)Exudate : is fluid that leaks around the cells of the capillaries caused by inflammation. Examples ? Pneumonia , connective tissue disease and malignancy 2)Transudate : is fluid pushed through the capillary due to high pressure within the capillary or decreased plasma oncotic pressure. Examples ? CHF , liver cirrhosis and nephrotic syndrome ## a condition that causes both exudate and transudate ? ? PE

How can we differentiate between the transudated and the exudated fluid clinically ? By ask for thoracocentesis , and then detect for the LDH ; if LDH<200 , transudate If LDH >200 , exudate

Lights criteria : Exudative effusions meet at least one of the following of Light’s criteria (transudates have none of these ) : • Protein (pleural)/protein (serum) >0. 5 • LDH (pleural)/LDH (serum) >0. 6 • LDH > two-thirds the upper limit of normal serum LDH

Symptoms and signs : 1)Dyspneaon exertion 2) Peripheral edema 3)Orthopnea, paroxysmal nocturnal dyspnea a. Dullness to percussion b. Decreased breath sounds over the effusion c. Decreased tactile fremitus

Diagnosis : 1)chest x-ray How much fluid must accumulate in pluera before an effusion can be detected ? ? ** what we can see on the x-ray ? ? Lateral decubitus films ? ?

2)Ct scan 3)Thoracocentesis : diagnostic & therapeutic Complication ? ? When we don’t use thoracocentesis ? ?

Treatment : 1. Transudative effusions a. Diuretics and sodium restriction b. Therapeutic thoracentesis—only if massive effusion is causing dyspnea 2. Exudative effusions: treat underlying disease 3. Parapneumonic effusions (pleural effusion in presence of pneumonia) a. Uncomplicated effusions: antibiotics alone (in most cases) b. Complicated effusions • Chest tube drainage & antibiotic

2)Empyema : Definition ? ? Cause ? ? Symptoms ? ? Diagnosis ? ?

Treatment ? ? 1)Drainage of the pleura ( via thoracocentesis ) 2)Antibiotic ** the recurrent drainage is common ** if severe and persistent >> rib resection and open drainage

3)Mesothelioma : Most cases are secondary to asbestosis It causes bloody effusion Symptoms : Dyspnea / weight loss / cough