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 fluid-filled 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 ;

200 , transudate>if LDH

200 , exudate < If LDH

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