diseases of pleura, diaphragm, chest wall Flashcards
what is pleurisy?
term used to describe pleuritic pain resulting from any number of disease processes involving pleura
common feature of pulmonary infection and infarction, may occur in malignancy
what are the clinical features of pleurisy?
sharp pain
aggravated by deep breathing or coughing
rib movement restricted
pleural rub may be present
loss of pleural rub may indiciate development of pleural effusion
every patient should have chest x ray
what is empyema?
pus in pleural space
can be thin or so thick that it is impossible to aspirate
neutrophil leucocytes present in large numbers
causative organism may or may not be isolated from pus
may involve whole pleural space or part of it usually unilateral
what are the different types of pleural effusion?
658 page
what is the cause of empyema?
secondary to infection in neighbouring structure, usually lung
most commonly due to bacterial pneumonias and TB
over 40% of patients with community-acquired pneumonia develop associated pleural effuson
what is the pathology of empyema?
both layers of pleura covered with thick, shaggy inflammatory exudate
pus in pleural space under considerable pressure and if condition not treated, pus may rupture into bronchus causing bronchopleural fistula and pyopneumothorax: track through chest wall with formation of subcutaneous abscess or sinus
when will empyema heal?
infection eradicated
empyema space obliterated allowing apposition of visceral and parietal pleural layers
occurs if re expansion of compressed lung is secured at early stage by removal of pus from pleural space
when is successful re expansion and resolution of empyema not evident?
IF THE VISCERAL PLEURA becomes grossly thickened and rigid due to delayed treatment or inadequate drainage of infected pleural fluid
pleural layers kept apart by air entering pleura through bronchopleural fistula
underlying disease in lung such as bronchiectasis, bronchial carcinoma, pulmonary TB preventing re-expansion
what are the clinical features of empyema? (systemic and local)
systemic: pyrexia, rigors, sweating, malaise, weight loss, polymorphonuclear leucocytosis
local: pleural pain, clinical signs of pleural effusion
what is spontaneous pneumothorax?
pneumothorax is presence of air in pleural space with can either occur spontaneously or result from iatrogenic injury or trauma to lung or chest wall
when does primary spontaneous pneumothorax occur?
patients with no history of lung disease in whom smoking, tall stature and presence of apical subpleural blebs additional risk factor
what are the clinical features of pneumothorax?
sudden onset unilateral pleuritic chest pain or breathlessness
underlying chest disease, breathlessness severe
what is the classification of pneumothorax?
primary spontaneous
secondary spontaneous: underlying liung disease (COPD, TB)
traumatic (iatrogenic
what is tension pneumothorax?
occasionally, communication between airway and pleural space acts as one way valve allowin air to enter pleural space during inspiration but not to escape on expiration
large amounts of trapped air accumulate in pleural space and intrapleural pressure rises well above atmospheric pressure
what happens to the lungs in tension pneumothorax?
pressure causes mediastinal displacement towards opposite side
compression of opposite normal lung and impairment of systemic venous return causing cardiovascular compromise
