Pleural pathology

Question 1

Normal mesothelium

Answer 1

single layer of mesothelial cells lines the pleural cavity. They secrete the hyaluronic acid

Question 2

Causes of pleural inflammtion

Answer 2

inflammatory diseases, infections, pulmonary infarction, emphysema, neoplasms, neoplasms, therapeutic, iatrogenic.

Question 3

symptoms of pleural inflammation

Answer 3

pleuritic chest pain (sharp, localised pain exacerbated by breathing. Sign: auscultation of a pleural rub during breathing (no pleural fluid to lubricate between pleurae); may well be associated with pleural effusion.

Question 4

Pathological fluids in pleural cavities

Answer 4

Liquids: serous fluids = pleural effusion),
pus = empyema or pylothorax (usually secondary to pneumonia),
blood = haemothorax usually traumatic,
bile = chylothorax usually traumatic, gas/ air = pneumothorax.

Question 5

PLEURAL EFFUSION

Answer 5

Excess fluid that accumulates in the pleural cavity.
Symptoms: breathlessness- effusion compresses the lung. Little/ no pleuritic pain. The visceral and parietal pleural are not in contact.
Treatment: remove the fluid by aspiration with a needle and syringe, ultrasound guided, re-aspirate if the fluid accumulates again. For recurrent effusions, consider a temporary or permanent pleural drain.

Question 6

Parietal pleural fibrous plaques

Answer 6

Associated with low level asbestos dust exposure. Asymptomatic

Question 7

Diffuse pleural fibrosis

Answer 7

associated with high level of asbestos exposure, usually bilateral. Dense cellular collagen not extending into interlobar fissures. Prevents normal expansion and compression of lung during breathing causing breathlessness. It’s a UK government prescribed occupational disease for specified.

Question 8

Malignant mesothelioma

Answer 8

Definition: neoplasm of the mesothelial cells that line serous cavities; pleura, peritoneum, pericardium, tunica vaginalis.
Epidemiology: 92% pleural, 8% peritoneal. Both are commoner in men. Peritoneal mesotheliomas affect a higher proportion of women, have a higher proportion of low grade type and are less strongly associated with
Aetiology:
Asbestos- 90% cases are caused by this, can be even small doses. Can take 15-60 years to develop. Thoracic irritation can be a risk factor, as can BAP1 (BRACA1- associated protein 1 mutations). Germ-line mutations in a familial cancer syndrome with unveal melanomas and mesotheliomas.
Can produce a large pleural effusion. The tumour can be difficult to identify on imaging and therefore it is difficult to target biopsies at it.

Question 9

Advanced malignant mesothelioma

Answer 9

tubulopapillary epitheliod & spindle cell sarcamatoid

Key clinical features: dyspnoea