Pleural Disease Flashcards
Pathologic involvement of the pleura is most often what?
Secondary to some other underlying disease
What are the 3 primary pleural diseases she wants us to know?
Effusions, pneumothorax and mesothelioma
What are the 5 scenarios where we would have an increases in pleural fluid and give an example for each?
- Increased hydrostatic pressure in CHF
- Increased vascular permeability in pneumonia
- Decreased osmotic pressure as in nephrotic syndrome
- Increased intrapleural pressure as in lung collapse
- Decreased lymphatic drainage
What is a pulmonary empyema?
Pus in the plural space typically due to a bacterial infection
What is the pus notorious for doing and what does the fluid look like in the pleural space?
Creating loculations, or web like traps for fluid.
Fluid is thick yellow and mars will show the bacteria and neutrophils.
How do we define pneumothorax and what are the three things it is most commonly associated with?
Air or gas in the pleural space. Emphysema, asthma and tuberculosis.
What is the clinically significant type of pneumothorax?
Spontaneous idiopathic in young adults.
What is tension pneumothorax?
When there is some type of injury or trauma to the chest wall and there is a one way valve created so air is only being sucked into the pleural space and not allowed to escape.
What is the difference in pressures between normal pneumothorax and tension pneumothorax?
In normal, the pleural cavity pressure is less than atmospheric pressure. In tension, pleural cavity pressure is greater than atmospheric pressure
What are the two frequent metastasis tumors to the pleura?
Lung and breast
What is mesothelioma associated with?
Asbestos exposure
What mutation is highly associated with mesothelioma?
Homozygous deletion of tumor suppressor gene CDKN2A/INK4a
What are the three types of mesothelioma? Which one is most common?
Epitheloid (most common), sarcomatoid, and mixed.
How do we distinguish epithelioid from adenocarcinoma?
Mesothelioma will stain positive for Carleton, WT1, cytokeratin 5/6, and D2 40.
What does the sarcomatoid type appear as and what marker does it usually stain strongest for?
Spindle cell sarcoma and usually may only stain positive for keratin.
