Download MBBS (Bachelor of Medicine, Bachelor of Surgery) 1st Year, 2nd Year, 3rd Year and Final year Pulmonary Medicine 5 Pleural Disorders PPT-Powerpoint Presentations and lecture notes
Pleural Disorders
Dept of Pulmonary Medicine
Learning Objectives
? What are various pleural disorders
? When to suspect Pleural effusion
? Symptoms & signs
? Basic Evaluation & Management
Anatomy & Physiology
? The normal pleura is a thin translucent membrane consisting of 1-
mesothelium, 2-thin layer of subendothelial connective tissue rich in
lymphatics, arteries veins and nerves.
? Functions:
? Space for movement &
? protective in volume overload
Types of Pleural Pathology
? Pneumothorax
? Effusion
? Haemothorax
? Pyothorax
? Chylothorax
? Hydro-pneumo
? Malignancies:Mesothelioma & metastasis
? Others
Symptoms
? Chest pain
? Cough
? Dyspnea
? +-Systemic features
Signs
? LN
? Clubbing
? Tachypnea/Tachycardia
? cynosis
Signs:Respiratory
? Inspection
? Palpation
? Persussion:Stony dul
? Auscultation:Rub
? Dec Breath sounds
Approach
? Detailed history and physical examination.
? imaging: CXR; Ultrasound Chest CT.
? Pleural fluid/tissue analysis.
Radiology
? PA view>200
? Lateral 75 ml
? USG 10 ml
? Ct sensitive
Thoracocentesis
? Diagnostic(not always needed)
? Therapeutic
? Transudative Vs Exudative
? Exudative:cells predominate
? Cytology & cultures
TYPES
? Transudative
? Exudative
? Extrapleural:transmigration
Pleural fluid analysis
? Colour/turbid
? Smear
? Smell
? Culture
? Protein
? Cytology
? Sugar
? ADA
? Cells
? HCT
? TLC/DLC
? TG/Cholesterol
? Amylase
LEADING CAUSES OF PLEURAL
EFFUSIONS
Causes
Annual Incidence
Transudate
Exudate
Congestive
heartfailure 50,00 Yes
No
Pneumonia 30,00 No
Yes
Cancer
20,00 No
Yes
Pulmonary
embolus 150,00 Sometimes Sometimes
Viraldisease 10,00 No
Yes
Cornary
arterybypass
surgery
60,00
No
Yes
CirhosiwiLigthht
ascites RW.Pleural5d0is,0ea0ses.4thed.LippincottYeWillsiams&Wilkins,2001 No
Investigations
? CXR
Clinical Scenario
? A 25 yr male:prot 3.5,sugar 55,cells 2000,L-90%
? 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
? A 65 male:prot 1.5,sugar 65,cells 200,L-90%
CASE
Pleural Fluid Analysis
67 yo man with dyspnea and Rt. Pleural effusion
Pleural Fluid
Serum
Nucleated Cell Count
1700; >90%Lymphocytes
Total protein: 4.0 g/dl
Total protein: 6.3 g/dl
LDH: 242 U/L
LDH: 143 U/L
Cytology : negative
Etiology
? Transudative
? Exudative
? CHF
? Pneumonia
? CLD
? Tb
? Renal Failure
? CA
? Anaemia/Hypoproteinemia
? Pulmonary Embolism:Both
? Myxedema
? Trauma
? Gross ascites
? Post surgery
? Inflammatory:RA/SLE
Management
? Tubercular:ATT+-steroids
? Parapneumonic:aspiration & antibiotics to ICD+fibrinolytics or Surgery
? Malignancy:Pleurodesis
? Rest:Treat underlying cause
This post was last modified on 08 April 2022