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 space resulting in collapse of the lung on the affected side.

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

Types of pneumothorax. Closed type. Open type. 'Tension' (valvular) type.

Tension Pneumothorax Most dangerous where communication Between Lungs and Pleura persists and act as a one way valve which allows air to enter the Pleural space during inspiration and coughing but prevents it from escaping. Thus pressure within Pleural space rapidly increases causing severe life threatening collapse of Lungs and Mediastinal displacement

Open Pneumothorax In this form an abnormal Communication is made between bronchus and Pleural space. (bronchopleural fistula ) communication fails to seal and air continues to transfer freely between the lung and pleural space. Air pressure in Pleural space is equal to atmospheric pressure in both phases of Respiration

Closed Pneumothorax The communication between Pleura and Lung seals off as the Lung deflates and does not to reopen. The air is gradually absorbed and Lung re-expands.

Pleural Effusion Pleural effusion is defined as an abnormal accumulation of fluid in the pleural space.

The following mechanisms play a role in the formation of pleural effusion: Increased capillary hydrostatic pressure in the systemic and/or pulmonary 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, including thoracic duct obstruction or rupture (eg, malignancy, trauma)

The accumulation of serous fluid within the pleural space is termed pleural effusion. Accumulations of frank pus (empyema) or blood (haemothorax) r Chyle (lymph) chylothorax

Common Causes of Pleural Effusion*

Transudative CCF Cirrhosis of Liver Nephrotic Syndrome Constrictive pericarditis Malnutrition Meig's Syndrome Malignant disease

Common Causes of Pleural Effusion*

Exudative Pulmonary TB Pneumonia Bronchial Carcinoma Pulmonary infarction Acute Pancreatitis Liver Abscess Sub phrenic abscess

Features 1. Occurrence
2. Cause

Exudative Inflammatory condition

Increased vascular permeability

3. Total Protein Content Same as plasma 4.Distribution of Protein As in Plasma 5. Specific Gravity High 6. Cells Plenty of Inflammatory Cells

Transudative Non inflammatory condition Increased Hydrostatic Pressure Less than in Plasma
Nearly all Albumin Low Few

LIGHT'S CRITERIA FOR DISTINGUISHING PLEURAL TRANSUDATE 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)

Pleural tumours Primary tumours Fibroma /Solitary Fibrous Tumor /(Benign Mesothelioma) Malignant mesothelioma (Asbestos may be the carcinogenic agent) Secondary metastatic tumour

Define & types of pneumothorax Write down the causes of Pneumothorax Define & write down the causes of pleural effusion Transudate & exudate difference