? What are various pleural disorders
? When to suspect Pleural effusion
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? Symptoms & signs
? Basic Evaluation & Management
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Anatomy & Physiology
? The normal pleura is a thin translucent membrane consisting of 1-
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mesothelium, 2-thin layer of subendothelial connective tissue rich inlymphatics, arteries veins and nerves.
? Functions:
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? Space for movement &
? protective in volume overload
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Types of Pleural Pathology
? Pneumothorax
? Effusion
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? Haemothorax? Pyothorax
? Chylothorax
? Hydro-pneumo
? Malignancies:Mesothelioma & metastasis
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? OthersSymptoms
? Chest pain
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? Cough? Dyspnea
? +-Systemic features
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Signs
? LN
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? Clubbing? Tachypnea/Tachycardia
? cynosis
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Signs:Respiratory? Inspection
? Palpation
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? Persussion:Stony dul
? Auscultation:Rub
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? Dec Breath soundsApproach
? Detailed history and physical examination.
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? imaging: CXR; Ultrasound Chest CT.
? Pleural fluid/tissue analysis.
Radiology
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? PA view>200
? Lateral 75 ml
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? USG 10 ml? Ct sensitive
Thoracocentesis
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? Diagnostic(not always needed)
? Therapeutic
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? Transudative Vs Exudative
? Exudative:cells predominate
? Cytology & cultures
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TYPES? Transudative
? Exudative
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? Extrapleural:transmigration
Pleural fluid analysis
? Colour/turbid
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? Smear
? Smell
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? Culture? Protein
? Cytology
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? Sugar
? ADA
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? Cells? HCT
? TLC/DLC
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? TG/Cholesterol
? Amylase
LEADING CAUSES OF PLEURAL
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EFFUSIONS
Causes
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Annual IncidenceTransudate
Exudate
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Congestive
heartfailure 50,00 Yes
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NoPneumonia 30,00 No
Yes
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Cancer
20,00 No
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YesPulmonary
embolus 150,00 Sometimes Sometimes
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Viraldisease 10,00 No
Yes
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Cornaryarterybypass
surgery
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60,00
No
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YesCirhosiwiLigthht
ascites RW.Pleural5d0is,0ea0ses.4thed.LippincottYeWillsiams&Wilkins,2001 No
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Investigations
? CXR
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Clinical Scenario
? A 25 yr male:prot 3.5,sugar 55,cells 2000,L-90%
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? A 35 yr male:prot 5.5,sugar 25,cells 3000,P-90%
? A 65 male:prot 5.5,sugar 65,cells 1000,L-90%,Hhagic
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? A 65 male:prot 1.5,sugar 65,cells 200,L-90%CASE
Pleural Fluid Analysis
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67 yo man with dyspnea and Rt. Pleural effusion
Pleural Fluid
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SerumNucleated Cell Count
1700; >90%Lymphocytes
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Total protein: 4.0 g/dl
Total protein: 6.3 g/dl
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LDH: 242 U/LLDH: 143 U/L
Cytology : negative
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Etiology? Transudative
? Exudative
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? CHF
? Pneumonia
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? CLD? Tb
? Renal Failure
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? CA
? Anaemia/Hypoproteinemia
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? Pulmonary Embolism:Both? Myxedema
? Trauma
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? Gross ascites
? Post surgery
? Inflammatory:RA/SLE
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Management
? Tubercular:ATT+-steroids
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? Parapneumonic:aspiration & antibiotics to ICD+fibrinolytics or Surgery? Malignancy:Pleurodesis
? Rest:Treat underlying cause
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