8 Pleural effusionDefinition: An accumulation of fluid between the layers of the membrane lining the lung and the chest cavity.Alternative names: Fluid in the chest; Transudative pleural effusion; Exudative pleural effusionCauses: Pleural fluid is normally formed in small amounts to lubricate the surfaces of the "pleura," the thin membrane that lines the chest cavity and surrounds the lungs. A "pleural effusion" is an abnormal collection of this fluid.
13 Pathophysiology of pleural effusion of pulm. capill. wedge pressure: cong. heart failure onc. pressure in microvas. circulation: low Se albumin in pressure in the pelural space: lung collapse due to ptx permeability of microvasc. circ.:due to inflam. mediatorsImpaired lymphatic drainage from pl. space: due to tu / fibrosisOcclusion of pariet. pleura stomata with fibrin, debris and mesoth. swellings: due to pneumoniaMovement of fluid from peritoneal space through diaphr. lymph. / diaphr. defect
14 ThoracocentesisDefinition: A procedure to remove fluid from the space between the lungs and the wall of the chest.How to prepare for the test: No special preparation is needed before the procedure. A chest X-ray is may be performed before and after the test. Do not cough, breathe deeply, or move during the test to avoid injury to the lung.Risks: pneumothorax (collapse of the lung), fluid re-accumulation, pulmonary edema, bleeding,infection, and respiratory distress.
16 Lab. analysis of pleural effussion ExsudateTransudate3 % protein3 % +Rivalta-0.5 Protein in pl. eff./ Se protein0.5 0.6 LDH in pl.eff/Se LDH0.6 1014 Specific gravity1014 inflammationCause syst./pulm. venous pressure
17 Common Causes of Exudative Effusion TuberculosisUnilateralLung ccBloody, large, parenchymal lesion on the X-ray, rapid. Reprod.PneumoniaX-ray:infiltr.Pulm. InfarctionBloody, pleural painLymphomaE.g.:Hodgkin disease, +mediast. Lg.Metastatic tumorLarge, rapid. Reprod.MesotheliomaBloody, Large, rapid. Reprod.TraumaBloody
18 Common Causes of Transudative Effusion Congestive heart failureBilateralCirrhosisAscites, Se protein low, usually on the right sideNephrotic syndromeHypoproteinaemia,Generalized oedema, ascites
19 3.Empyema = pus in the pleural space Cause:bacteria: Staphylococcus aureus, Klebsiella pn, E. Coli, Mycobact. Tb, anaerobic bact.Appear: as the complication of bacterial pneumonia, subdiaphragmatic abscess, oesophageal perforation, following thoracic surgerySymptomes:Chest painDyspnoeFeverNight sweatsWeight loss
20 Empyema 2. Physical examination: Signs of pleural fluid Percussion note: dullAuscultation: diminished/absent breath soundsX-ray: Signs of pleural fluidTherapyDrainage of pleural spaceAntibioticsIn the case of uneffective th: thoracotomy, pleural peel
21 II. Pneumothorax= air in the pleural space complete or partial II. Pneumothorax= air in the pleural space complete or partial collapse of the lungSymptomes:Chest painDyspnoePhysical signPercussion note:HyperresonanceBreath sounds: diminished/absentX-ray: visible pleural edge with no lung markings between this edge and the chest wallTherapy: depends on the size of the ptxsmall: O2 th, close observation, suction of the air by needlelarge:consant tube drainagepleurodesissurgery
22 Potential causes of pneumothorax Air: outside the chest wallTraumaThoracocentesis, pleural biopsy, TTBInsertion of venous catheterAir: from the airwaysIdiopathicRupture of oesophagusCOPDPos.pressure ventillationInfection, tumor, foreign body
26 Tension PTXA tension PTX is a life-threatening condition that requires immediate intervention.Causes: penetrating chest injuries, fractures of the trachea or bronchi, a ruptured esophagus, the presence of an occlusive dressing over an open PTX, and PPV.Progressive build-up of pressure in the pleural space pushes the mediastinum to the opposite hemithorax, and obstructs venous return to the heart. This leads to circulatory instability and may result in traumatic arrest. Symptomes: patient is tachycardic and tachypnoeic, and may be hypoxic. These signs are followed by circulatory collapse with hypotension and subsequent traumatic arrest with pulseless electrical activity (PEA). Breath sounds and percussion note may be very difficult to appreciate and misleading in the trauma room.Mrtg: Deviation of the trachea away from the side of the tension.Shift of the mediastinum.Depression of the hemi-diaphragm.Th:emergent chest decompression with needle thoracostomy. A 14-16G intravenous cannula is inserted into the second rib space in the mid-clavicular line. The needle is advanced until air can be aspirated into a syringe connected to the needle.Constant tube drainage