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    DR M Abdur Rahim M.D.:, Asst. Professor of Medicine

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    The document discusses three pleural diseases: pleurisy, pleural effusion, and pneumothorax. Pleurisy is inflammation of the pleura causing sharp chest pain that worsens with breathing or coughing. Pleural effusion is an accumulation of fluid in the pleural space that can cause breathlessness. Pneumothorax is the presence of air in the pleural space, often caused by trauma or lung disease, and patients experience sudden chest pain and difficulty breathing. The document provides details on symptoms, investigations like x-rays, and management approaches for each condition such as drainage and treatment of underlying causes.

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    DR M Abdur Rahim M.D.:, Asst. Professor of Medicine

    Uploaded by

    dr_abdur
    133 views43 pages
    The document discusses three pleural diseases: pleurisy, pleural effusion, and pneumothorax. Pleurisy is inflammation of the pleura causing sharp chest pain that worsens with breathing or coughing. Pleural effusion is an accumulation of fluid in the pleural space that can cause breathlessness. Pneumothorax is the presence of air in the pleural space, often caused by trauma or lung disease, and patients experience sudden chest pain and difficulty breathing. The document provides details on symptoms, investigations like x-rays, and management approaches for each condition such as drainage and treatment of underlying causes.

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    Pleural Disease

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    The document discusses three pleural diseases: pleurisy, pleural effusion, and pneumothorax. Pleurisy is inflammation of the pleura causing sharp chest pain that worsens with breathing or coughing. Pleural effusion is an accumulation of fluid in the pleural space that can cause breathlessness. Pneumothorax is the presence of air in the pleural space, often caused by trauma or lung disease, and patients experience sudden chest pain and difficulty breathing. The document provides details on symptoms, investigations like x-rays, and management approaches for each condition such as drainage and treatment of underlying causes.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    133 views43 pages

    DR M Abdur Rahim M.D.:, Asst. Professor of Medicine

    Uploaded by

    dr_abdur
    The document discusses three pleural diseases: pleurisy, pleural effusion, and pneumothorax. Pleurisy is inflammation of the pleura causing sharp chest pain that worsens with breathing or coughing. Pleural effusion is an accumulation of fluid in the pleural space that can cause breathlessness. Pneumothorax is the presence of air in the pleural space, often caused by trauma or lung disease, and patients experience sudden chest pain and difficulty breathing. The document provides details on symptoms, investigations like x-rays, and management approaches for each condition such as drainage and treatment of underlying causes.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 43

    DR M ABDUR RAHIM M.D.

    ,
    ASST. PROFESSOR OF MEDICINE

    PLEURITIC DISEASES

    Pleurisy Pleural Effusion Pneumo Thorax

    Pleurisy
    Pleuritic pain resulting from any disease process involving the Pleura. Clinical Features : Sharp Pain that is aggravated by deep breathing or coughing. On examination : Rib movement is restricted Pleural Rub may be present

    Some times audible only in deep Inspiration or near the Pericardium (Pleuro-Pericadial Rub) Loss of Pleural Rub & Diminution in chest painIndicate eithery recovery or development of a Pleural Effusion Investigation : Chest X-Ray PA View

    Management : Primary cause to be treated Symptomatic treatment To allow the patient to breathe normally and cough efficiently Analgesic with Paracetamol, Cocodamol or NSAID is sufficient Some patients require Opiates To be used with Caution

    PLEURAL EFFUSION
    Accumulation of Serous fluid within Pleural Space is termed as Pleural Effusion Pus Empyema

    Blood Haemo Thorax Chyle Chylo Thorax

    Mechanism :
    Fluid accumulates as a result of either increased Hydrostatic Pressure of Decreased Osmotic Pressure ( Transudative Effusion ). OR From increased Microvascular Pressure due to disease of the pleural surface itself or injury in the adjacent lung ( Exudative Effusion ).

    Clinical Features : Pleurisy precede the development of an effusion. Onset may be insidious. Breathlessness Only symptom related to effusion, severity depends on size & rate of accumulation.

    Investigations : Imaging : CXR-PA View Ultra sonography CT

    CHEST X-RAY PA VIEW

    Ultrasonography : More accurate for determining the volume of oral fluid. Fecilitates skin marking for safe needle aspiration

    Pleural Aspiration & Biopsy : Colour Texture Appearance Presence of Blood- Pulmonary Infraction Malignancy Truamatic Tap

    Biochemical Analysis : Differntiate Transudate from Exudate

    Gram Stain Para Pneumonic Effusion. Cytologic Examination Biopsy : Video-assisted Thoracoscopy

    Management : Aspiration of Pleural Fluid Treatment of underlying cause.

    Pneumothorax
    Air in pleural space which occur spontaneously or result from Iatrogenic injury or Trauma to the Lung or Chest Wall

    Clinical Features : Sudden onset unilateral pleuritic chest pain Breathlessness Severe in Underlying Chest disease. Small Pneumothorax- Normal Large Pneumothorax (>15% of Hemi thorax)Decreased or Absent Breath sounds Resonant Percussion note.

    Types of Spontaneous Pneoumothorax


    Communication between the Airway and the Pleural space acts as a one way Valve. Air enter Pleural Space during Inspiration but doesnot escape on Expiration. Intra Pleural pressure rises above atmospheric level.

    The pressure causes Mediastinal shift to opposite side Compression of opposite normal lung Impairment of systemic venous return causing Cardiovascular compromise Rapidly progressive breathlessness Clinically Tachycardia, Hypotension, Cyanosis and Tracheal Shift opposite to silent hemi thorax

    Communication between the airway and pleural space seals of as the lung deflates and doesnot reopen. Mean pleural pressure remains ve, reabsorption of air and re expansion of lung occur over a few days or weeks

    Communication fails to seal and air continues to pass freely between Bronchial tree and pleural space Commonly seen following rupture of an Emphysematous bulla, Tuberculous cavity or lung absess into the pleural space.

    Investigation : Chest X-Ray Sharply defined edge of the deflated lung with complete translucency between this and chest wall. CT

    Management : Primary Pneumothorax- Lung edge < 2 cm from chestwall-resolves without intervention. Moderate or Large Spontaneous primary PneumothoraxPercutaneous needle aspiration of air

    Chronic Underlying Lung Disease, Secondary Pneumothorax causing Respiratory DistressIntercostal tube drainage Intercostal Drains are inserted in the 4th, 5th or 6th ICS in mid axilary line, connected to an underwater seal or oneway Heimlich Valve Drain removed 24 hrs after lung has fully reinflated and bubbling stopped

    Continued Bubbling after 5-7 days Surgery Recurrent spontaneous Pneumothorax- 25% Surgical Pleurodesis is recomended

    Empyema
    Collection of pus in Pleural space Pus may be thin as serous fluid or thick as impossible to aspirate. Microscopically, Neutrophil Leucocytes are present in large numbers. May involve the whole pleural space or only part of it (Loculated) and is usually Unilateral.

    Aetiology : Secondary to infection in a lung (bacterial pnuemonias and TB) Other causes of sub absces Trauma or Surgery Esophegeal Rupture phrenic

    Pathology : Thick Shaggy, inflammatory exudate Pus under considerable pressure Pus may rupture into a Bronchus (Bronocho Pleural Fistula) or track through the Chestwall to form Subcutatneous absces or Sinus (Empyema necessitans)

    Clinical Features : Suspected in patient with pulmonary infection with persisting Pyrexia despite treatment

    Investigations : Radiological Examinations As of Pleural Effusion Horizontal Fluid levelPyopneumothorax Ultrasound and CT Aspiration of fluid Thick and turbid- Empyema

    Other Features suggesting Empyema Fluid Glucose < 60 mg/dL LDH > 1000 units/Lt Fluid pH < 7 Pleural Biopsy, Histology and Culture To differentiate TB and NonTuberculous disease.

    Management : Treatment of Non-Tuberculous Empyema Intercostal tube drain connected to underwater-seal Antibiotic Treatment- 2 4 weeks I.V Co-Amoxiclav or I.V Cefuroxime with Metronidazole Surgical Decortication

    Treatment of Tuberculous Empyema Intercostal tube drainage Anti Tuberculosis treatment Complications calcificaton Fibrothorax Pleural

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