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Respiratory > Pleural & Mediastinal Pathology > Flashcards

Pleural & Mediastinal Pathology Flashcards

1
Q

What types of cells are in pleural membranes?

A

normally flat cuboidal epithelia

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2
Q

What is the definition of pleural effusion?

A

Accumulation of fluid (>15mL) in the pleural space secondary to: Increase in hydrostatic pressure, Decreased osmotic pressure & Increased vascular permeability

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3
Q

How does pleural effusion manifest clinically?

A
  • Dyspnea, pleuritic pain, cough
  • Enlarged hemithorax: dullness on percussion & decreased or absent breath sounds
  • Compression of the lung: atelectasis leading to respiratory distress
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4
Q

How do you diagnose and treat pleural effusion?

A

Dx: Chest X-ray, Thoracentesis, Analysis of pleural fluid or Pleural biopsy (percutaneous, open)

Tx underlying cause

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5
Q

What are common causes of pleural effusions?

A
  • Infections
  • Pulmonary embolism
  • Malignant neoplasms
  • Trauma
  • Systemic conditions
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6
Q

What are the inflammatory pleural effusions?

A
  • Serofibrinous
  • Suppurative (empyema)
  • Hemorrhagic
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7
Q

What are the non-inflammatory pleural effusion?

A
  • Hydrothorax
  • Hemothorax
  • Chylothorax
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8
Q

What causes Serous, fibrinous and serofibrinous pleural effusions?

A

inflammatory conditions such as pneumonia, T.B., lung infarcts, abscesses

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9
Q

What causes empyema?

A

localized accumulation of pus due to organisms

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10
Q

What causes hemorrhagic pleuritis?

A

coagulopathies, rickettsial disease, malignant neoplasms

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11
Q

How does empyema look?

A

Pleural surface is coated by shaggy thick fibrin layer admixed with greenish purulent exudate and organization produces adhesions and loculation circumscribing the pus and limiting lung expansion

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12
Q

How do you treat empyema?

A

Surgical decortication is treatment of choice

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13
Q

What is hydrothorax?

A

clear serous fluid (cardiac failure, pulmonary congestion

and edema, cirrhosis, uremia, renal failure)

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14
Q

What is a hemothorax?

A

hemorrhagic fluid (ruptured aortic aneurysm, trauma)

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15
Q

What is a chylothorax?

A

milky fluid from lymph (thoracic duct trauma or lymphatics occlusion secondary to malignancy)

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16
Q

What is a pneumothorax?

A

Presence of air or gas within the pleural cavity can be spontaneous, traumatic or therapeutic

commonly associated with emphysema, asthma and tuberculosis

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17
Q

What is Spontaneous idiopathic pneumothorax?

A

young individuals secondary to rupture of small apical lung blebs – the trachea is deviated to the ipsilateral side – usually subsides spontaneously

18
Q

What is Tension pneumothorax?

A

defect acts as a flap that permits entrance of air during inspiration but does not allow escape of air during expiration

19
Q

What are general mechanisms of pneumothorax?

A
  • Perforation of the visceral pleura and entry of air from the lung
  • Penetration of air from the chest wall, diaphragm, mediastinum or esophagus
  • Gas-forming organisms in empyema
20
Q

What are the symptoms of pneumothorax?

A
  • Chest pain, dyspnea
  • Absent breath sounds on auscultation
  • Tympanitic percussion (hyper-resonance)
  • Contralateral deviation of the trachea on CXR
  • Compression and collapse of lung parenchyma with atelectasis
  • Marked respiratory distress
21
Q

What can cause tension pneumothorax?

A

Due to penetrating trauma to the lungs

22
Q

What is Solitary Fibrous Tumor?

A
  • Polypoid, well-circumscribed, pedunculated
  • Composed of fibroblasts with abundant collagenized stroma
  • Benign tumor, cured by simple excision
23
Q

What are the symptoms of Solitary Fibrous Tumor?

A

Mostly asymptomatic and discovered incidentally on chest X-rays

Associated with hypoglycemia and clubbing of the fingers

24
Q

What is malignant mesothelioma?

A

Neoplastic proliferation of mesothelial cells lining serosal surfaces

25
Q

what is the distribution of mesothelioma?

A

Affects 15-20 persons per million/per year in the general population

Most common in adults over 50

26
Q

What can cause mesothelioma?

A
  • Asbestos exposure
  • Radiation
  • Chronic inflammation
  • Viral infections (SV40 simian virus in old polio vaccines)
  • Idiopathic (up to 50% of cases)
27
Q
  • Lifetime risk for developing mesothelioma is up to 10% in patients with a history of heavy exposure
  • Long latency period (20-40 years)
  • Occupational exposure: millworkers, roofing materials, textiles, insulation, shipyard workers

Is characteristic of what?

A

Asbestos-related Mesothelioma

28
Q

What are the symptoms of Asbestos-related Mesothelioma?

A
  • Insidious, slow growing neoplasm
  • Recurrent pleural effusions
  • Chest pain and dyspnea in more advanced stages
  • Only 20% of patients have pulmonary fibrosis
  • Fatal malignancy; median survival 18 months
29
Q

What happens pathologically in mesothelioma?

A

Tumor characteristically spreads along mesothelial surfaces composed of bland-appearing cuboidal cells

spares parenchyma

30
Q

Metastatic tumors are more common than primary malignancies in the pleura, where do they usually come from?

A

Lung is the most frequent source of metastases to the pleura; other tumors include breast and ovarian cancer, pancreas, kidney and spread is by blood, lymphatics or direct extension

31
Q

What is acute mediastinitis?

A

Complication of conditions affecting neighboring organs; i.e., esophageal perforation, perforation of lung abscess, sternal osteomyelitis

32
Q

What is granulomatous mediastinitis?

A

Chronic disorder secondary to fungal or mycobacterial infection

33
Q

What organisms can cause Granulomatous mediastinitis?

A
  • Histoplasmosis
  • Tuberculosis
  • Cryptococcosis
  • Atypical mycobacteria
  • Aspergillosis
34
Q

What are congenital cysts?

A
  • Usually unilocular
  • Children aged 5 to 15 years
  • Lined by simple cuboidal epithelium
  • May be filled with serous fluid
35
Q

What is Thymic Hyperplasia?

A

Thymic lymphoid follicular hyperplasia: associated with myasthenia gravis and other autoimmune disorders

36
Q
  • Neoplastic proliferation of thymic epithelial cells
  • Usually contains abundant immature T-lymphocytes
  • Frequently associated with myasthenia gravis and other paraneoplastic syndromes
  • May be composed of spindle cells or round epithelioid cells
  • Slow-growing tumor that may recur but rarely metastasizes

Are characteristics of what?

A

thymoma

37
Q

What are the symptoms of thymoma?

A
  • Asymptomatic in 30% of patients
  • Cough, dyspnea, chest pain
  • Superior vena cava syndrome
  • Paraneoplastic syndromes
38
Q

What Paraneoplastic syndromes are associated with thymoma?

A
  • Myasthenia gravis
  • Pure red cell aplasia
  • Hypogammaglobulinemia
  • Agranulocytosis; white blood cell aplasia
  • Polymyositis; SLE
  • Pemphigus vulgaris, disseminated herpes
39
Q

What is prognosis for thymoma?

A

• Depends on the status of the capsule – Encapsulated tumors are cured by complete
surgical excision and Invasive tumors tend to recur repeatedly and may eventually metastasize
• Recurrent tumors may progress to thymic carcinoma

40
Q

What is the histology of thymic carcinoma?

A

• Resemble other types of
carcinoma occurring in other organs (squamous, small cell, adenocarcinoma, etc)
• Diagnosis of exclusion (i.e., there are no specific features that permit definite histologic
diagnosis)

Respiratory (15 decks)

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