3Pleural fluidNormally 10-15ml of pleural fluid is present in the pleural cavity.Pleural fluid is produced by pairetal & visceral layers.Most of the fluid is removed by the lymphatics, remaining fluid lubricates the lung & chest wall.
4Pleural effusionIs the accumulation of excess fluid in the pleural cavity.Important manifestationNormally, no more than 15ml of serous fluid present. This fluid is acellular, clear fluid that lubricates the surface.
6Etiology of pleural effusion Increased hydrostatic pressure, as in congestive cardiac failure.Increased vascular permeability, as in Pneumonias.Decreased osmotic pressure, as in Nephrotic syndrome.Decreased lymphatic drainage, as in Mediastinal carcinomatosis.
7Clinical featuresPleuritic chest pain- increases on inspiration, coughing, sneezingDyspnea
8Clinical features500ml of fluid should be present to produce the signsBulging of intercostal spaces on the affected sideDiminished mobility of chest wallShift of mediastinum to the opposite sideStony dullness on percussionBronchial breath sounds on auscultation.
9Types of pleural effusion Trasudate-Congestive cardiac failure-Cirrhosis of liver-Nephrotic syndromeExudate-Pneumonias-Tuberculosis-Pulmonary embolism-Malignancy
10Types of pleural effusion based on etiology Non-inflammatory effusionInflammatory effusion
26Sequelae of pleural effusion Permanent collapse of the lung (Compression atelactesis)Pleural thickening, AdhesionsEmpyema
27PneumothoraxAccumulation of air in the pleural cavity.
28Causes of pneumothorax Spontaneous:Emphysema,Bronchial asthma, Tuberculosis.2. Traumatic:Perforating injury to the chest wall3.Therapeutic:Was once used in treatment of tuberculosis
29Types of pneumothoraxClosed type- the opening is very small & heals spontaneouslyOpen type- the opening is large & remains patentTension- the opening is valvular(air enters the pleural space during inspiration but cannot escape during expiration so that a positive pressure occurs in the pleural cavity.
30Clinical features Pleuritic chest pain Dyspnea Collapse Crack pot sound on percussionHyper-resonent sound on auscultation
33Clinical significance of Pneumothorax Compression of pleura on lung may lead to Atelactasis & leading to Respiratory distress.Tension pneumothorax- results if the defect acts as ball valve permitting entry of air & preventing escape of air.
49Macroscopic examination Volume: a 24 hrs sputum is measured in chronic bronchitis, lung abscess, bronchial asthma. An increasing volume of sputum indicates bad prognosis.Colour: normal sputum is clear & colorless.Yellowish- infectious process like pneumoniaGreenish tint- pseudomonasRust colored- pneumococcal pneumoniaBright red- pulmonary infarction, tuberculosis, malignancy.
503. Odour: normal sputum is odourless. Putrid odour- seen in lung abscess, cavitary tuberculosis.
51Microscopic examination Gram’s stain-detect various bacteriaZiehl Neelson’s stain- detect AFBPap’s/ H&E stain- for cytological examination. Normally sputum shows few tracheobronchial cells, occasional squamous cells & inflammatory cells.
58Advantages of sputum cytology Less expensiveOPD basedNo anesthesia requiredNon invasive
59DisadvantagesDetects lesions which opens into bronchi. Peripheral lung lesions may be missed.Difficult in children, comatose patients.Contamination with oral secretions.
60Bronchial washingsAn bronchoscope is passed via trachea into bronchioles & about 5ml of balanced salt solution is introduced.Solution introduced is aspirated back & collected in a sterile container.Solution is smeared, stained with PAP’s stain & examined.
61AdvantagesNo dilution with oral secretionsUseful in children