Pleura

Question 1

Pleural Diseases (4)

Answer 1

1. Pleural effusion
2. Pleurisy
3. Pneumothorax
4. Pleural malignancy

Question 2

Transudate vs exudate

Answer 2

• T: low protein fluid, usually due to high hydrostatic pressure, low oncotic pressure
• E: high protein fluid, due to damage to vessel walls or inflammatory reaction to tumour/infection

Question 3

Abnormal accumulations in the pleural cavity

Answer 3

• Pus - empyema
• Blood - hemothorax
• Chyle - chylothorax - leakage from thoracic duct
• Air - pneumothorax

Question 4

Types & causes of pneumothorax (3)

Answer 4

1. Spontaneous
   - primary - thin young men, rupture of congenital sup pleural apical bleb
   - secondary - rupture of emphysematous bulla, asthmatics, rupture of congenital cyst, malignancy, cystic fibrosis, pneumonia, sarcoidosis, whooping cough
2. Traumatic
   - penetrating chest wounds, rib fractures, esophageal rupture
3. Iatrogenic
   - subclavian cannulation, positive pressure artificial ventilation, pleural aspiration, esophageal perforation during endoscopy, lung biopsy

Question 5

Features of pleurisy

Answer 5

• or pleuritis - acute inflammation of the pleura
• causes: infection, copmlication of pneumonia, connective tissue diseaes
• fibrinous/purulent exudate - may become organised to form fibrous pleural adhesions - reduces compliance

Question 6

Features of pleural malignancy

Answer 6

1. Mesothelioma - primary neoplasm of the pleura, rare, usually assoc w asbestos exposure
   - M: tubular (epithelioid) or spindle cell (sarcomatoid) pattern
   - spread around & encases lung & mediastinal structures
   - poor prognosis
2. Metastatic carcinoma is more common