L14 Pericardial and Pleural Disease, Vascular Tumours Flashcards
Causes of Pericardial Effusion?
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
4 Types of Pericardial Effusion?
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
Complication of Pericardial Effusion?
Leads to cardiac Tamponade
_______________: inflammation of the pericardium
Cause?
Complications?
Alleviation?
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.
______________________: 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
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
All types of pneumothorax may cause ____________, _____________, ____________ of lung and associated respiratory distress
All types of pneumothorax may cause compression, collapse, atelectasis of lung and associated respiratory distress
________________: collapse of previously inflated lung tissue
Results?
3 Types?
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]
Types of Pneumothorax? (4)
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
_______________: 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?
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.
___________= Fluid within the pleural cavities (15 mL or more)
Most Common Causes?
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
Types of Pleural Effusion?
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.
Causes of Pleuritis?
Causes:
Inflammation within the lung (pneumonia, TB, abscess, bronchiectasis)
Systemic diseases (rheumatoid arthritis, lupus)
____________________: Arises from the pleural mesothelial lining
Risk factors?
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!!!
____________:
Macrophages ingest fibers, release chemotactic factors and fibrogenic mediators, causing interstitial fibrosis
Begins in ______________ , progresses to _____________
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
Detection of Asbestos Bodies?
Asbestos body detection: H&E, Perls Prussian blue (iron stain)
Most common primary tumor of heart (~40-50%), although still rare?
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.
___________________
Usually benign; excision curative
Occurs in wide age range
Arises from modified smooth muscle cells of _________
Occur_s under fingernails_ usually
EXTREMELY painful
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
______________
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
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
__________________
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
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
____________
Almost always a birthmark
Caused by a vascular anomaly (capillary malformation in the skin)
Benign
Port-Wine Stain
Almost always a birthmark
Caused by a vascular anomaly (capillary malformation in the skin)
Benign
_________________: 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
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
__________________
- 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?
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
___________________
- 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?
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)
