Pleural Pathology Flashcards

1
Q

describe the structure of the normal mesothelium

A

single layer of mesothelial cells which secrete hyaluronic acid and rich mucous pleural fluid

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2
Q

what are various causes of pleural inflammation

A
primary inflammatory diseases 
infections 
pulmonary infarction 
emphysema 
pleural neoplasms 
therapeutic (pleurodesis) 
latrogenic (radiotherapy)
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3
Q

what is the paythogensis of pleural fibrosis

A

secondary to pleural inflammation the fibrosis prevents expansion and compresses the lung - breathlessness and adhesion

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4
Q

what is pleural decortication

A

removing fibrous tissue to improve respiration

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5
Q

what is a classical marker in the lungs of asbestos exposure

A

pleural fibrous plaques

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6
Q

what is the difference between parietal pleural fibrous plaques and diffuse pleural fibrous plaques

A

PPFP - low level exposure to asbestos and asymptotic

DPFP - high level asbestos exposure
symptomatic with breathlessness

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7
Q

what are three types of pathological fluids in the pleural cavity

A

pus - empyema or pyothroax secondary to pneumonia

blood - haemothroax - trauma

bile - chylothroax - trauma

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8
Q

liquid or serous fluid in the pleural cavity is called what

A

pleural effusion

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9
Q

what is a transudate pleural effusion (PE) and its causes

A

low protein and lactate hydrogenase
low capillary oncotic pressure or high hydrostatic pressure pushes fluid into pleura
may be due to left ventricular failure or renal failure = backlog into pulmonary circulation

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10
Q

what is an exudate pleural effusion (PE) and its causes

A

high protein and lactate hydrogenase

caused by inflammation without infection

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11
Q

what are the signs and symptoms of plural effusion

A

breathlessness, pain

dull to percuss and reduced breath sounds

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12
Q

what is the treatment of pleural effusion

A

breathlessness - remove the fluid by aspriation or pleurodesis

treat underlying cause

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13
Q

what is gas or air in the pleural cavity called

A

pneumothorax

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14
Q

what are the differences between the 3 types of pneumothorax

A

open - chest wall perforation in trauma - sucking chest wound - air in during inspiration which reduces lung expansion

closed - lung perforation from ruptured emphysematous bullae - inflammation

tension - open or closed are valvular so let air in but not out which compresses mediastinum structures such as the heart or contralateral lung

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15
Q

what are the common signs and symptoms of pneumothorax

A

breathlessness and chest pain, cyanosis, tachycardia, contralateral trachea deviation

percussion - hyperressonant
auscultation - reduced breath sounds

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16
Q

what are the various treatment for pneumothorax

A

valvular aspiration
if one - cover chest wound
if recurrent - pleurodesis

17
Q

what are the differences between primary and secondary neoplasms

A

primary - benign/low grade = rare or malignant mesothelioma

secondary - carcinomas from breast or lung

18
Q

what by definition is a malignant mesothelioma

A

a neoplasm of mesothelial cells that line serous cavities - pleura peritoneum pericardium or tunica vaginalis

19
Q

who are most at risk to malignant mesothelioma

A

men

20
Q

what is the difference between an early mesothelium and an advanced one

A

early - large pleural effusion

advanced - spread to other cavities and metastasise

21
Q

what is the histology of malignant neoplasm of the pleura

A

tubulopapillary epithelia and spindle cell sarcomatoioid

22
Q

what is the cause of malignant mesothelioma

A

asbestos - 80-90% and develops over 60 years

thoracic irradiation or BAp1 mutations

23
Q

what are the three types of asbestos

A

amphibole - blue (crocidolite), brown (amosite)

serpentine - white (chrysolite)

24
Q

which types of asbestos are the mis oncogenic

A

amphiboles - mainly crocidolite - persists in the lungs

25
Q

how is an asbestos body formed

A

coated by mucopolysaccharides containing iron

26
Q

what is asbestosis

A

high levels of asbestos does causing interstitial pneumonia like progressive pulmonary interstitial fibrosis