EFUSI PLEURA

ANATOMI PARU-PARU
ANATOMI PARU-PARU
Paru kanan: Paru kiri:
o3 lobus o2 lobus
• (dipisahkan oleh fisura mayor • (dipisahkan oleh fisura mayor)
dan fisura minor)
o8 segments
o10 segments
 SEGMENTASI PARU KANAN
Superior Lobe Apical segment (1)
Posterior segment (2)
Anterior segment (3)
Middle Lobe Lateral segment (4)
Medial segment (5)
Inferior Lobe Apicobasal segment (6)
Mediobasal segment (7)
Anterobasal segment (8)
Laterobasal segment (9)
Posterobasal segment (10)
 SEGMENTASI PARU KIRI
Superior Lobe Apicoposterior segment (1)
Anterior segment (2)
Lingula segments Superior segment (3)
Inferior segment (4)
Inferior Lobe Apical segment (5)
Anteromedial basal segment (6)
Laterobasal segment (7)
Posterobasal segment (8)
ANATOMI TRAKTUS RESPIRATORIUS
 ANATOMI TRAKTUS RESPIRATORIUS
Trachea :
•Dimulai dari batas bawah kartilago krikoid setinggi
verterbra C6.
•Memanjang sampai ke carina setinggi sternal angle
(vertebra T5).
•Setinggi vertebra T4 saat ekspirasi
•Setinggi vertebra T6 saat inspirasi
•Trakea memiliki panjang 15 cm dan diameter 2 cm.
ANATOMI TRAKTUS RESPIRATORIUS
Primary lobule
• Unit fungsional terkecil dari paru. The smallest functional unit of the lung
• Mencakup seluruh struktur yang lebih distal dari respiratory bronchiole termasuk 16-40
alveoli.
• Orang dewasa normal memiliki sekitar 23 juta primary lobules.
Acinus
• Mencakup seluruh struktur yang lebih distal dari terminal bronchioles termasuk pembuluh
darah, syaraf, dan jaringan ikat.
•diameter 4-8 mm.
•Terdiri dari 10-20 primary lobules. approximately 10-20 primary lobules
Secondary Lobule
•The smallest structural unit of lung parenchyma that is surrounded by a connective tissue
septum.
•Contains 3-12 acini and measures 1,0-2,5 cm in diameter.
ALVEOLI
Alveoli pore:
Canals of Lambert
• between alveoli and terminal
bronchiole
Pores of Kohn
• between alveoli.

10
Pleura viseral menutupi bagian paru
dan menempel pada semua
bagiannya, termasuk pada fisura
horizontal maupun obliqueIn cadaver
dissection, the visceral pleura cannot
usually be dissected from the surface of
the lung. It provides
the lung with a smooth slippery surface,
enabling it to move
freely on the parietal pleura. The
visceral pleura is continuous
with the parietal pleura at the hilum of
the lung, where
structures making up the root of the
lung (e.g., bronchus and
pulmonary vessels) enter and leave the
lung (Fig. 1.30C).
The parietal pleura lines the
pulmonary cavities, thereby
adhering to the thoracic wall,
mediastinum, and diaphragm.
It is thicker than the visceral
pleura, and during surgery and
cadaver dissections, it may be
separated from the surfaces it
covers. The parietal pleura
consists of three parts—costal,
mediastinal, and diaphragmatic—
and the cervical pleura
The visceral pleura is separated from the parietal pleura by a small amount of
pleural fluid that allows almost frictionless movement during respiration. The blood
supply of the parietal pleura comes from the systemic arteries and veins, including the
posterior intercostal, internal mammary, anterior mediastinal, and superior phrenic
arteries, and corresponding systemic veins.
The blood supply of the visceral pleura is systemic and pulmonary.
The lymphatic drainage of the parietal pleura is into
PLEURA
There are two layers:
• The parietal pleura is a mesothelial lining of each hemithorax that invaginates at the hilum of each
lung.
• The visceral pleura: the continuation of parietal pleura that cover each lung.
 Between these two surfaces is the potential pleural space, which is normally occupied only by a thin
layer of lubricating pleural fluid.
 Irritation of the parietal surface by inflammation, tumor invasion, trauma, and other processes can lead
to a sensation of chest wall pain. The visceral pleura has no somatic innervation.
 Between 5 and 10 L of fluid normally enters the pleural space daily by filtration through microvessels
supplying the parietal pleura (located mainly in the less dependent regions of the cavity).
 Normally, 15 to 20 mL of pleural fluid is present at any given time.
PLEURAL EFFUSION
•Any significant collection of fluid within the pleural space.
•General classification of pleural fluid
Characteristics Transudate Exudate
Composition Protein-poor ultrafiltrates Protein rich pleural fluid
of plasma
Causes Alterations in the systemic Inflammation or invasion of
hydrostatic pressures or the pleura by the tumor
colloid osmotic pressure
(congestive heart failure or
cirrhosis)
Gross Clear or straw colored Turbid, bloody or purulent
pleural fluid to serum ratio <0,5 >0,5
of protein
LDH ratio <0,6 >0,6
MALIGNANT PLEURAL EFFUSION
EMPYEMA
CHYLOTHORAX
ACCESS AND DRAINAGE OF PLEURAL FLUID
COLLECTIONS
Needle aspiration
With careful appraisal of the x-ray
findings, the best interspace is selected,
and fluid is aspirated with a needle
and syringe. Large volumes of fluid can
be removed with a little patience and a
large-bore needle.
Chest tube insertion
After careful skin preparation, draping, and administration of local anesthesia, a short skin incision is
made over the correct interspace.
The incision is deepened into the intercostal muscles, and the pleura is penetrated (usually with a
clamp).
When any doubt exists about the status of the pleural space at the site of puncture, the wound is
enlarged bluntly to admit a finger, which can be swept around the immediately adjacent pleural
space to assess the situation and break down any adhesions.
The tube is inserted, with the tip directed toward the optimal position suggested by the chest x-rays.
In general, a high anterior tube is best for air (pneumothorax) and a low posterior tube is best for
fluid. A 28 to 32F tube is adequate for most situations. A 36F tube is preferred for hemothorax or
for a viscous empyema. Many surgeons prefer a very small tube (16 to 20F) for drainage of simple
pneumothorax.
Water Seal Drainage
The tube is connected to a water-seal drainage system. Suction is added, if
necessary, to expand the lung; it usually will be required in a patient with a
substantial air leak (bronchopleural fistula).
COMPLICATIONS OF PLEURAL DRAINAGE
• puncture of the underlying lung, with air leakage and pneumothorax; subdiaphragmatic entry, with
damage to the liver, spleen, or other intra-abdominal viscera; bleeding secondary to intercostal vessel
injury, or most commonly, larger vessel injury; and even cardiac puncture.
• bleeding may be the result of an underlying coagulopathy or anticoagulant therapy
• technical complications include loss of a catheter, guidewire, or fragment in the pleural space, and
infections.
• postexpansion pulmonary edema: shortness of breath, clinical instability following rapid drainage of a
large effusion .

For this reason, it is recommended to drain only up to 1 L initially