Pleural disorders Pleural effusion pathogenesis An increase in

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Pleural disorders

Pleural disorders

Pleural effusion

Pleural effusion

pathogenesis • An increase in hydrostatic pressure in the microvascular circulation (CCF). • A

pathogenesis • An increase in hydrostatic pressure in the microvascular circulation (CCF). • A decrease in oncotic pressure in the microvascular circulation (hypoalbuminemia). • Increase permeability of the microvascular circulation (pneumonia). • Impaired lymphatic drainage from the pleural space (malignancy). • Movement of fluid from the abdomen into the pleural space (cirrhosis)

Physical exam • decrease chest expansion in the affected side , absent, decreased tactile

Physical exam • decrease chest expansion in the affected side , absent, decreased tactile fremitus, stony Dullness to percussion, Decreased breath sounds and Egophony.

Radiology

Radiology

or a lateral and decubitus views

or a lateral and decubitus views

Investigations ü pleural fluid microbiology 1)gram stain c/s 2)Afb smear and c/s ü Pleural

Investigations ü pleural fluid microbiology 1)gram stain c/s 2)Afb smear and c/s ü Pleural fluid cell count and diff cell count ü Biochemstry protein , LDH and glu ü Pathology for malignant cells ü Other specific pcr /ct/autoantibodies depend on case.

transudate • Causes: • Heart liver failure and nephrotic syndrome

transudate • Causes: • Heart liver failure and nephrotic syndrome

exudate Appearance of fluid Type of fluid Predominant cells Other DX feature TB CLOUDY

exudate Appearance of fluid Type of fluid Predominant cells Other DX feature TB CLOUDY BLOODY YELOW Exudate Lymphocytes- + TT & pl. biopsy 80% Malignant disease often blood – stained Exudate lymphoctes Positive pl. biopsy 40% Pul. infarction bl. stained exudate RBC Source of embolism Rheumatoid disease Serous YELOW Exudate Lymphocyte) RF , ANTI CCP SLE serous Exudate Lymph. Anti-DNA Chyle None Chylomicrons Obst. of thoracic Millky duct

Empyema • Defined as pus in the pleural space. • low ph Intercostal tube

Empyema • Defined as pus in the pleural space. • low ph Intercostal tube & iv antibiotic +_decortication 20

CHEST TUBE DRAINAGE SYSTEM 21

CHEST TUBE DRAINAGE SYSTEM 21

pneumothorax

pneumothorax

• Thank u

• Thank u

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