3 Pleural 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.
4 Pleural 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.
6 Etiology 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.
7 Clinical featuresPleuritic chest pain- increases on inspiration, coughing, sneezingDyspnea
8 Clinical 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.
9 Types of pleural effusion Trasudate-Congestive cardiac failure-Cirrhosis of liver-Nephrotic syndromeExudate-Pneumonias-Tuberculosis-Pulmonary embolism-Malignancy
10 Types of pleural effusion based on etiology Non-inflammatory effusionInflammatory effusion
11 Non inflammatory effusion HydrothoraxHaemothoraxChylothorax
12 Hydrothorax Accumulation of serous fluid Unilateral or bilateral depending on the cause.Causes- Congestive cardiac failureNephrotic syndromeCirrhosis of liverPrimary & Secondary tumors
13 Nature of Hydrothorax Is a transudate Clear, straw colored Protein content lessVery few cells.
14 Haemothorax Accumulation of blood Causes- -Trauma to the chest wall -Ruptured aortic aneurysm
15 ChylothoraxAccumulation of milky fluid of lymphatic origin
16 Causes of chylothorax Thoracic duct trauma Obstruction to the thoracic duct by secondary malignancyFilariasis
26 Sequelae of pleural effusion Permanent collapse of the lung (Compression atelactesis)Pleural thickening, AdhesionsEmpyema
27 PneumothoraxAccumulation of air in the pleural cavity.
28 Causes of pneumothorax Spontaneous:Emphysema,Bronchial asthma, Tuberculosis.2. Traumatic:Perforating injury to the chest wall3.Therapeutic:Was once used in treatment of tuberculosis
29 Types 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.
30 Clinical features Pleuritic chest pain Dyspnea Collapse Crack pot sound on percussionHyper-resonent sound on auscultation
33 Clinical 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.
49 Macroscopic 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.
50 3. Odour: normal sputum is odourless. Putrid odour- seen in lung abscess, cavitary tuberculosis.
51 Microscopic 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.
58 Advantages of sputum cytology Less expensiveOPD basedNo anesthesia requiredNon invasive
59 DisadvantagesDetects lesions which opens into bronchi. Peripheral lung lesions may be missed.Difficult in children, comatose patients.Contamination with oral secretions.
60 Bronchial 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.
61 AdvantagesNo dilution with oral secretionsUseful in children