L14 Pericardial and Pleural Disease, Vascular Tumours

Question 1

Causes of Pericardial Effusion?

Answer 1

Pericarditis

Infections (e.g. TB)

Inflammatory disorders, such as lupus, rheumatoid arthritis

Myocardial infarction pericarditis, Dressler’s syndrome (months after infarc)

Cancer that has spread to the pericardium

Kidney failure increases urea nitrogen

Hypothyroidism

Heart surgery (postpericardotomy syndrome) -> effusion postoperatively

Question 2

4 Types of Pericardial Effusion?

Answer 2

Types:

Transudative (congestive heart failure, myxoedema {hypothyroidism}, nephrotic syndrome)

Exudative (due to inflammation, infection, e.g. tuberculosis)

Hemorrhagic: chest trauma, ruptured MI, aortic dissection)

Malignant: due to fluid accumulation caused by metastasis

Question 3

Complication of Pericardial Effusion?

Answer 3

Leads to cardiac Tamponade

Question 4

_______________: inflammation of the pericardium

Cause?

Complications?

Alleviation?

Answer 4

Pericarditis: Inflammation of the pericardium

Most often due to a viral infection

Can cause pericardial effusion and eventually cardiac tamponade

Classified according to composition of fluid within cavity

Pain better sitting up/forward and worse with lying down or breathing deep.

Question 5

______________________: medical condition characterized by a thickened, fibrotic pericardium, limiting the heart’s ability to function normally => prevents the heart from expanding when blood enters it

Answer 5

Constrictive Pericarditis: medical condition characterized by a thickened, fibrotic pericardium, limiting the heart’s ability to function normally => prevents the heart from expanding when blood enters it

Question 6

All types of pneumothorax may cause ____________, _____________, ____________ of lung and associated respiratory distress

Answer 6

All types of pneumothorax may cause compression, collapse, atelectasis of lung and associated respiratory distress

Question 7

________________: collapse of previously inflated lung tissue

Results?

3 Types?

Answer 7

ATELECTASIS: collapse of previously inflated lung tissue

=>results in areas of lung tissue that are airless => decreased oxygenation

Types of Atelectasis:

Obstruction:(tumor/excess secretions from asthma, COPD, post-op) of an airway & with complete obstruction will cause resorption of air distal to the obstruction

Compression from outside: Pleural effusion, empyema, pneumothorax, pleural tumor

Contraction of lung/pleural tissues: Fibrotic changes in the lung tissue or pleural tissues [prevent expansion]

Question 8

Types of Pneumothorax? (4)

Answer 8

Types of Pneumothorax:

Spontaneous: Due to abscess, tuberculosis, infection, emphysema/COPD, asthma, connective tissue diseases (rheumatoid arthritis, Marfan syndrome)

Spontaneous idiopathic: Young people, rupture of small, peripheral, apical subpleural blebs, usually subsides spontaneously, but may recur and be disabling

Traumatic: due to puncture of chest wall or lung

Tension Pneumothorax = Medical Emergency!!

Progressive build-up of air within the pleural space. Air escapes into the pleural space but does not to return (One-way valve effect)

Caused by an open chest wound or damaged/injured lung/airway

=> Pocket of air grows => pressure rises inside the cavity and compresses the lung

Question 9

_______________: formation of fibrotic bands that span the pleural space between the parietal and visceral layers of the pleura. They may be thought of as internal scar tissue that connects tissues not normally connected.

Causes?

Answer 9

Pleural Adhesions: formation of fibrotic bands that span the pleural space between the parietal and visceral layers of the pleura. They may be thought of as internal scar tissue that connects tissues not normally connected.

Question 10

___________= Fluid within the pleural cavities (15 mL or more)

Most Common Causes?

Answer 10

Pleural Effusion= Fluid within the pleural cavities (15 mL or more)

Most common causes are congestive heart failure and metastatic disease

For lung, breast and ovarian metastases, 92% of pleural effusions ipsilateral to the primary lesion

Question 11

Types of Pleural Effusion?

Answer 11

Inflammatory Pleural Infusion

Serous, serofibrinous or fibrinous

Empyema:

Pus/abscess in pleural cavity due to bacteria or fungal seeding of pleural space, often from lung infection

Organizes into dense adhesions

Fibrinous inflammation:

Inflammation characterized by fibrin deposition due to the exudation of a high concentration of the plasma protein fraction

Associated with chronic inflammation rather than acute

Non-Inflammatory Pleural Infusion

Hydrothorax: Clear/straw coloured fluid; usually due to congestive heart failure

Hemothorax: Blood in pleural space. Usually due to rupture of aneurysm or vascular trauma; associated with large clots

Chylothorax: Lymphatic fluid/lymph in pleural space.

Question 12

Causes of Pleuritis?

Answer 12

Causes:

Inflammation within the lung (pneumonia, TB, abscess, bronchiectasis)

Systemic diseases (rheumatoid arthritis, lupus)

Question 13

____________________: Arises from the pleural mesothelial lining

Risk factors?

Answer 13

Malignant Mesothelioma:

Arises from the pleural mesothelial lining

Risk factors:

Asbestos exposure is the main risk factor: FIBROGENIC (promote fibrosis of tissues) act as a tumor initiator and promoter

Radiation

Tobacco is NOT a risk factor for mesothelioma

For lung adenocarcinoma combination of asbestos exposure & tobacco use, Relative Risk = 55x!!!

Question 14

____________:

Macrophages ingest fibers, release chemotactic factors and fibrogenic mediators, causing interstitial fibrosis

Begins in ______________ , progresses to _____________

Answer 14

Asbestosis

Macrophages ingest fibers, release chemotactic factors and fibrogenic mediators, causing interstitial fibrosis

Begins in lower lobes and subpleurally, progresses to middle and upper lobes

Question 15

Detection of Asbestos Bodies?

Answer 15

Asbestos body detection: H&E, Perls Prussian blue (iron stain)

Question 16

Most common primary tumor of heart (~40-50%), although still rare?

Answer 16

Cardiac Myxoma

Most common primary tumor of heart (~40-50%), although still rare

Sporadic or familial (familial = Carney Syndrome/Complex)

Carney autosomal dominant

Those w/ present at younger age ~24

90% occur in atria, 80% on left side.

Question 17

___________________

Usually benign; excision curative

Occurs in wide age range

Arises from modified smooth muscle cells of _________

Occur_s under fingernails_ usually

EXTREMELY painful

Answer 17

Glomus Tumor

Usually benign; excision curative

Occurs in wide age range

Arises from modified smooth muscle cells of glomus body

Occur_s under fingernails_ usually

EXTREMELY painful

Question 18

______________

Common benign tumor, particularly in childhood

Superficial head / neck (1/3 in liver)

Malignant transformation rare

Present at birth and expand with growth of child; may regress at puberty

Answer 18

Hemangioma

Common benign tumor, particularly in childhood

Superficial head / neck (1/3 in liver)

Malignant transformation rare

Present at birth and expand with growth of child; may regress at puberty

Question 19

__________________

Hemangioma which occurs in infancy, usually on the face/head & neck region.

Begin as a small flat red area but usually develop into a raised dimpled lesion.

Begins to retract spontaneously at age 3-4

Resolves w/o scarring

Answer 19

Strawberry Naevus

Hemangioma which occurs in infancy, usually on the face/head & neck region.

Begin as a small flat red area but usually develop into a raised dimpled (strawberry-like) lesion.

Begins to retract spontaneously at age 3-4

Resolves w/o scarring

Question 20

____________

Almost always a birthmark

Caused by a vascular anomaly (capillary malformation in the skin)

Benign

Answer 20

Port-Wine Stain

Almost always a birthmark

Caused by a vascular anomaly (capillary malformation in the skin)

Benign

Question 21

_________________: Malformations due to failure of lymphatics to communicate with venous system

_________________:

–In children, usually in neck or axilla; may extend into mediastinum

–Complete surgical excision is recommended to prevent recurrence

Answer 21

Lymphangioma: Malformations due to failure of lymphatics to communicate with venous system

Cystic/cavernous lymphangioma (cystic hygroma):

–In children, usually in neck or axilla; may extend into mediastinum

–Complete surgical excision is recommended to prevent recurrence

Question 22

__________________

• Tumor caused by infection with human herpesvirus 8 (HHV8)
• Common in AIDS epidemic
• Systemic disease that presents with cutaneous lesions w/ or w/o internal organ (GIT, lungs, lymph nodes, mouth) involvement
• Highly vascular: abnormally dense and irregular blood vessels leak red blood cells into the surrounding tissue
  
  • CLASSIFICATION?

Answer 22

Kaposi Sarcoma

• Tumor caused by infection with human herpesvirus 8 (HHV8)
• Common in AIDS epidemic
• Systemic disease that can present with cutaneous lesions with or without internal organ (GIT, lungs, lymph nodes, mouth) involvement
• Highly vascular: abnormally dense and irregular blood vessels leak red blood cells into the surrounding tissue

Question 23

___________________

• Highly aggressive with frequent recurrences and metastasis
• Poor prognosis/high mortality rate
• Arises from endothelial cells of blood vessels
• POSITIVE for _______, _________ (vascular markers).
• NEGATIVE FOR ______________
• Situations that it arrises?

Answer 23

Angiosarcoma

• Highly aggressive with frequent recurrences and metastasis
• Poor prognosis/high mortality rate
• Arises from endothelial cells of blood vessels
• POSITIVE for CD31, Factor VIII (vascular markers)
• NEGATIVE for HHV8

Classically arises in one of three scenarios:

–Head (scalp & face) and neck of the elderly (sun-exposed areas)

–Chronic lymphedema

–Post radiation (usually in the setting of breast cancer)