T6 - L4 Pleural Pathology

Question 1

what type of cell lines the plural cavity?

Answer 1

a single layer of mesothelial cells

Question 2

what do mesothelial cells secrete? what is the clinical relevance of this?

Answer 2

• hyaluronic acid

- lubricates movement of the visceral and parietal pleura against each other during respiration

Question 3

what can cause inflammation of the pleura?

Answer 3

• Primary inflammatory diseases
• Infections
• Pulmonary infarction
• Emphysema
• Neoplasms
• Therapeutic
• Latrogenic

Question 4

give an example of a primary inflammatory disease that can cause pleural inflammation.

Answer 4

systemic lupus erythematosus

rheumatoid arthritis

Question 5

give an example of a viral infection that can cause pleural inflammation.

Answer 5

primary Coxsackie B infection (Bornholm disease)

Question 6

how does pleural inflammation present?

Answer 6

• Pleuritic chest pain,
• a sharp localised pain exacerbated by breathing
• Auscultation of a pleural rub

Question 7

what is pleural fibrosis secondary to?

Answer 7

pleural inflammation

Question 8

what are the effects of pleural fibrosis?

Answer 8

can prevent normal expansion and compression of the lung during respiration causing breathlessness

Question 9

what are parietal pleural fibrous plaques?

Answer 9

Pleural plaques are discrete circumscribed areas of hyaline fibrosis of the parietal pleura and occasionally the visceral pleura.

Question 10

what are they symptoms of parietal pleural fibrous plaques?

Answer 10

asymptomatic

Question 11

what are parietal pleural fibrous plaques associated with?

Answer 11

low level asbestos and dust exposure

Question 12

what is diffuse pleural fibrosis?

Answer 12

Pleural thickening -extensive scarring thickens the lining of the lungs caused by asbestos exposure

Question 13

what is a pleural effusion?

Answer 13

serious fluid in the pleural cavity

Question 14

what is empyema?

Answer 14

pus in the pleural cavities

usually secondary to pneumonia

Question 15

what is prothorax

Answer 15

pus in the pleural cavities

usually secondary to pneumonia

Question 16

what is haemothorax?

Answer 16

blood in the pleural cavity

usually traumatic or a ruptured thoracic aortic aneurysm

Question 17

what is chylothorax?

Answer 17

bile in the pleural cavity

usually traumatic

Question 18

what is a pleural effusion?

Answer 18

is the build-up of excess fluid between the layers of the pleura outside the lungs.

Question 19

what are the two types of pleural effusions?

Answer 19

1. transudates

2. exudates

Question 20

what are the features of a transudate pleural effusion?

Answer 20

• low capillary oncotic pressure
• high capillary hydrostatic pressure
• intact capillaires retain semipermeability
• low protein and low lactate dehydrogenase

Question 21

what are the features of a exudate pleural effusion?

Answer 21

• pathological capillaries lose semipermeability
• normal capillary oncotic pressure
• normal vascular hydrostatic pressure
• high protein and high lactate dehydrogenase

Question 22

what are causes of transudate pleural effusions?

Answer 22

high vascular hydrostatic pressure:

• left ventricular failure
• renal failure

low capillary oncotic pressure:
-Hypoalbumenaemia – hepatic cirrhosis, nephrotic syndrome

Question 23

what are causes of exudate pleural effusions?

Answer 23

• inflammation with or without infection

Question 24

how does a pleural effusion present?

Answer 24

• Breathlessness - effusion compresses the lung

- Little/no pleuritic pain – the visceral and parietal pleura are not in contact

Question 25

how do you treat a pleural effusion?

Answer 25

Treat breathlessness by removing the fluid

aspiration

Identify and treat underlying cause

Question 26

how would you treat a recurrent pleural effusion?

Answer 26

Reaspirate if the fluid reaccumulates

• For recurrent effusions consider a temporary or permanent pleural drain
• For recurrent effusions when the lung expands after drainage and the underlying cause remains consider pleurodesis to obliterate the pleural cavity

Question 27

what is pleurodesis?

Answer 27

• a procedure in which a medication is injected into the pleural space in order to minimize the amount of fluid that can collect there.
• pleurodesis is generally a long-term, even permanent solution to prevent the accumulation of pleural fluid.

Question 28

what is pneumothorax?

Answer 28

air in the pleural cavity

Question 29

What are the two types of pneumothorax?

Answer 29

1. Open Pneumothorax

2. Closed Pneumothorax

Question 30

what is open pneumothorax?

Answer 30

• chest wall perforation

- usually traumatic

Question 31

what is closed pneumothorax?

Answer 31

• a lung perforation

Question 32

what is the name for a malignant primary pleural neoplasm?

Answer 32

malignant mesothelioma

Question 33

What is a malignant mesothelioma?

Answer 33

A neoplasm of the mesothelial cells that line serous cavities - pleura, peritoneum, pericardium,
tunica vaginalis

Question 34

what are the two main causes for malignant mesothelioma?

Answer 34

• asbestos

- BAP1 mutations

Question 35

what are the two types of asbestos?

Answer 35

- Amphibole:
blue asbestos (crocidolite) - brown asbestos (amosite) 

• Serpentine:
  white asbestos (chrysotile)

Question 36

which type of asbestos is the most oncogenic?

Answer 36

Amphiboles particularly crocidolite

Question 37

which type of asbestos is the least oncogenic?

Answer 37

chrysotile

Question 38

what is asbestosis?

Answer 38

interstitial fibrosis

caused by high level exposure to asbestos dust

Question 39

what are asbestos corns?

Answer 39

benign hyperkeratotic wart-like skin lesions