1. Diseases of pleura
Beatrix Bálint MD.

2. Pleural cavity

3. Pleura
Apex
Lat. mellkasfal
Mediastinum
diafragma

4. Diseases of pleura
Inflammation = pleurisy
Pneumothorax
Tumor

5. Inflammation of pleura
1. Pleuritis sicca
Cause: viral infection
Bornholm’s disease
Coxsackie B
Symptomes:
Pleuritic chest pain
Pleural friction rub
Therapy:
symptomatical

6. 2. Pleural effusion:aetiology:multifactorial
Symptomes
Chest pain
Dyspnoe
Physical examination
Percussion note: dull
Auscultation: diminished/absent breath sounds
X-ray
Small fluid: blunting of costo-phrenic angleű
Larger volume (>300 ml):homogenous shadow
Therapy
Thoracocentesis
To treat the cause of the pelural effusion

7. Pleurisy

8. Pleural effusion
Definition: 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 effusion
Causes: 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.

9. Pleural effusion

10. Pleural effusion

11. Pleural effusion

12. Pulmonary embolism

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. mediators
Impaired lymphatic drainage from pl. space: due to tu / fibrosis
Occlusion of pariet. pleura stomata with fibrin, debris and mesoth. swellings: due to pneumonia
Movement of fluid from peritoneal space through diaphr. lymph. / diaphr. defect

14. Thoracocentesis
Definition: 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.

15. Pleural effusion: analysis
Quantity
Quality: color, density, opacity
Lab. analysis
Chemical
Cytological
Bacteriological: culture
Spec
Aspec.

16. Lab. analysis of pleural effussion
Exsudate
Transudate
3 % 
protein
3 %  +
Rivalta -
0.5 
Protein in pl. eff./ Se protein
0.5 
0.6 
LDH in pl.eff/Se LDH
0.6 
1014 
Specific gravity
1014 
inflammation
Cause
 syst./pulm. venous pressure

17. Common Causes of Exudative Effusion
Tuberculosis
Unilateral
Lung cc
Bloody, large, parenchymal lesion on the X-ray, rapid. Reprod.
Pneumonia
X-ray:infiltr.
Pulm. Infarction
Bloody, pleural pain
Lymphoma
E.g.:Hodgkin disease, +mediast. Lg.
Metastatic tumor
Large, rapid. Reprod.
Mesothelioma
Bloody, Large, rapid. Reprod.
Trauma
Bloody

18. Common Causes of Transudative Effusion
Congestive heart failure
Bilateral
Cirrhosis
Ascites, Se protein low, usually on the right side
Nephrotic syndrome
Hypoproteinaemia,
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 surgery
Symptomes:
Chest pain
Dyspnoe
Fever
Night sweats
Weight loss

20. Empyema 2. Physical examination: Signs of pleural fluid
Percussion note: dull
Auscultation: diminished/absent breath sounds
X-ray: Signs of pleural fluid
Therapy
Drainage of pleural space
Antibiotics
In 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 lung
Symptomes:
Chest pain
Dyspnoe
Physical sign
Percussion note:Hyperresonance
Breath sounds: diminished/absent
X-ray: visible pleural edge with no lung markings between this edge and the chest wall
Therapy: depends on the size of the ptx
small: O2 th, close observation, suction of the air by needle
large:consant tube drainage
pleurodesis
surgery

22. Potential causes of pneumothorax
Air: outside the chest wall
Trauma
Thoracocentesis, pleural biopsy, TTB
Insertion of venous catheter
Air: from the airways
Idiopathic
Rupture of oesophagus
COPD
Pos.pressure ventillation
Infection, tumor, foreign body

23. Pneumothorax

24. Pneumothorax

25. Pneumothorax

26. Tension PTX
A 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

27. Tension PTX

28. III. Pleural tumors 1. Primery tumor = mesothelioma
Localised form: solitary growth on pleural surface
Th: surgical resection
Diffuse mesorhelioma:highly malignant tu.
Symptomes: chest pain, cough, dyspnoe
X-ray: rapidly reproducated peural effusion
Dg: cytological examination of the effusion
Th: symptomatical
2. Metastatic tumor: malignant pleural effusion caused by primery tumor of the body: breast cc., lung cc.

29. Köszönöm a figyelmet!