pleurisy Flashcards
definition
- inflammation of the pleura, secondary to disease of the lung
dry types
Dry type - Pleurisy characterized by a fibrinous exudation, resulting in adhesion between the surfaces of the pleura. Also called adhesive pleurisy, fibrinous pleurisy, plastic pleurisy.
effusion types
- Effusion type - pleural space lies between the lung and chest wall and normally contains a very thin layer of fluid. Present when there is an excess quantity of fluid in the pleural space
inflammatory effusion – serous, serofibrous, purulent, Hemorrhagic
etiology - effusion
- In serous and serofibrinous pleurisy: TB, Pneumonia, Certain infection, Rheumatism
- In purulent: pneumococci, streptococci, staphylococci
- in Hemorrhagic type :
a. TB of pleura
b. Bronchogenic cancer of the lung with the involvement of the pleura and injury to the chest
etiology - dry
- complications of respiratory tract infections, such as pneumonia, viral infections, and tuberculosis.
- tumor or an injury
- gastrointestinal tract diseases (liver and pancreas) which inflame the diaphragm and the portions of the pleurae that cover the diaphragm.
pathogenesis - effusion
In serous pleurisy - due to allergic reaction
- In purulent type - complication of bronchopneumonia (inflammation to pleura turn to abscess and open to pleural cavity). inflammation of the pleura attended by increase permeability of the wall of the affected capillary of the pulmonary pleura
pathogenesis dry
In dry pleurisy - thickening of the pleura and deposition of fibrin, pleural membrane become dull and hyperemic commisure and adherence develop
clinical symptoms - effusoin
In pleurisy with effusion:
- fever
- pain and feeling of heaviness in the affected side
- dyspnea, mild cough
- gen condition - grave in purulent pleurisy - increase T, chills and sign of general toxicosis
- mostly are asymptomatic and discovered during physical examination or on chest x-ray.
clinical symptoms - dry
In dry pleurisy:
- cough is usually dry
- weakness and subfebrile
- respiration is superficial (deep breathing cause pain due to friction)
- lying on the affected side lessen the pain
- Sharp, stabbing pain towards the side and lower part of the chest. Radiate to shoulders, neck and abdomen. breathing or coughing, will aggravate the pain, shortness of breath
investigation - effusion
- Inspection : asymmetry of the chest due to enlargement of the affected side.
- Palpation: Vocal fremitus not transmitted at the area of fluid accumulation
- Percussion : over the of fluid are dull sound
a. transudate > freely press the lung and Damoisseau curve not determined
b. Garland triangle on affected side and has dull tympanic sound
c. Rauchfuss –Grocoo triangle on the healthy side
investigation
In dry pleurisy :
- Inspection : unilateral thoracic lagging during respiration
- Percussion : decrease mobility of the lung on the affected side
- Auscultation : pleural friction rub on the affected site
- X-ray : limited mobility of the diaphragm
- Blood: moderate leucocytosis .
investigation
- Thoracentesis: Fluid may be clear yellow (serous), milky (chylous), blood-tinged (serosanguineous), grossly bloody (sanguineous), or translucent or opaque and thick (purulent). Specimens should be taken for chemical, bacteriologic, and cytologic examination.
- lateral decubitus radiograph
- thoracoscopy
- needle biopsy of the pleura; open pleural biopsy
- CT scans: evaluating the underlying lung parenchyma in pleural disease; lung abscess, pneumonia, or bronchogenic carcinoma beneath loculated pleural effusion; lung abscess differentiated from empyema with a bronchopleural fistula and an air-fluid level; Pleural plaques differentiated from parenchymal lesions; pleural densities of mesothelioma are readily identified.
- perfusion lung scanning and / or pulmonary arteriography
variants of exudate
Feature Transudative Exudative
Appearance
Clear, thin, non clotting Cloudy, viscous
LDH
Normal Increase
Protein
< 30 g/l >30g/l
Relative density
1.006- 1.012 1.018-1.022
Rivalto’s reaction
Negative Positive
WBC
Absent / few Large num , RBC
Fluid/ serum LDH ration
< 0.6 > 0.6
Fluid / serum protein ration
<0.5 > 0.5
variants of exudate
- transudative: LVF, pulmonary embolism and cirrhosis
- exudative: bacterial pneumonia, malignancy, viral infection, and pulmonary embolism
- transudative pleural effusion occurs when systemic factors that influence the formation and absorption of pleural fluid are altered
- exudative pleural effusion occurs when local factors that influence the formation and absorption of pleural fluid are altere
role of x-ray
In dry pleurisy : Limited movement of diaphragm
In pleurisy with effusion : Homogenous density over the area of dullness
- precise way to confirm physical findings and demonstrate the presence of pleural fluid.
- upper border of the fluid is meniscus-shaped.
- patient upright, the minimum amount of detectable fluid ranges from 200 to 500 mL.
- in lateral decubitus view, < 100 mL of fluid is detectable.
- Large pleural effusions result in complete opacification of the hemithorax and in mediastinal shift to the contralateral side.
- Adhesions between visceral and parietal pleurae may result in atypical loculated collections.
- Loculations in the horizontal or oblique fissure may be confused with an intrapulmonary tumor and are called “vanishing tumors.”
- Obliteration of the costophrenic angle usually denotes a fibrosing and healing reaction and may remain after healing is complete.
- Pleural plaques due to asbestos exposure present as localized areas of pleural thickening, sometimes calcified, and usually in the lower 2/3 of the thorax
