Flashcards in Lecture 4 - PATHOLOGY Deck (33):
Where do you find normal mesothelium?
Lines the pleural cavity
What do mesothelial cells secrete?
Hylauronic acid - lubricates movement between visceral + parietal pleura
What are the 3 types of pleural pathology?
What are the causes of pleural inflammation?
Primary inflammatory diseases – causes pleura to thicken
o SLE (collagen vascular diseases)
o Rheumatoid arthritis (AI)
• Infections – secondary to pneumonia/ TB
o Viral primary coxsackle B infection (pleural pain)
• Pulmonary infarction – secondary to pulmonary arterial thromboembolus
• Emphysema – secondary to rupture bullae. Localised inflammation
• Neoplasms – primary or secondary pleural neoplasms inflammation of pleura
• Therapeutic pleurodesis (obliteration of pleural cavity by adding talc - causing parietal + visceral pleura to stick together)
• Iatrogenic radiotherapy to thorax/ immune reaction to drugs
If the patient has pleural inflammation, what are the symptoms and signs?
Pleuritic chest pain when inhaling
Signs - hear pleural rub.
What is Pleural fibrosis
What external substance do you breathe in that can cause pleural fibrosis?
• Secondary to pleural inflammation
What are the symptoms of pleural fibrosis?
Breathless, bc fibres prevent lung from expanding + contracting
How to treat pleural fibrosis?
Pleural decortication - removing fibrous tissue
What are the 2 types of pleural fibrosis plaques?
Parietal pleural plaque
Diffuse pleural plaque
What is parietal pleural plaque?
Type of pleural fibrosis
Dense cellular collagen
Caused by low level asbestos
What is Diffuse pleural plaque
Type of pleural fibrosis
Dense cellular collagen within the membrane, but not into the intelrobar fissure. Doesn't affect the mediastinum.
Caused by high level asbestos
What are the 4 types of fluid you can find in pleural cavities?
Serous fluid – plural effusion
Causes breathlessness – fluid in pleural cavity compresses lungs
Pus empyema - pyothorax
Secondary to pneumonia spreading to pleura pleural cavity
Blood - haemothorax
♣ Caused by trauma (fractured rib)
♣ Bleeds into pleural cavity
Bile - chylothorax
♣ Caused by trauma (thoracic duct damaged)
Gas - Air – pneumothorax
What is pleural effusion?
FLuid in pleural cavity?
How does transudate fluid get in to plural cavity?
o High vascular hydrostatic pressure - c
o Low cap oncotic pressure Hypoalbuminaemia, Hepatic cirrhosis, nephrotic syndrome
How does exudate fluid get into pleural cavity?
Abnormal blood vessels leak proteins
Caused by inflammation +/- infection (i.e. pneumonia damaging capillaries)
What are the 2 causes of high vascular hydrostatic pressure?
What are they caused by?
How does this affect the lung?
Caused by left ventricular failure --> PULMONARY OEDEMA
Kidney failure --> FLUID OVERLOAD
Can cause pleural effusion
How to diagnose effusion?
• Breathless – effusion compresses lungs
• No pleuritic pain
• Signs - dull percussion, decr breath sounds
• Investigations imaging (ultrasound/ CXR)
How to treat an effusion?
What to do if the effusions are recurrent?
• Remove fluid
• If recurrent effusions, consider temp/ permanent pleural drain
• Severe cases pleurodesis obliterate pleural cavity to prevent further effusion
• Treat underlying cause
o Local pleural fluid – look for malignant cells/ inflammation. Do a biopsy
What is a pneumothorax?
Air in pleural cavity
What are the 2 types of pneumothorax?
Open pneumothorax - caused by chest was perforation
What are the causes of a closed pneumothorax?
• Ruptured emphysematous bullae (air spaces in lung surrounding normal lung tissue)
• Inflamm lung disease asthma/a pneumonia, TB, CF
o Have cystic bullae on lung surface that can rupture
• Cystic lung disease e.g. Langerhan’s cell histiocytosis,
o Cysts rupture
• Pleural endometriosis endometrium breakdown, causing leak to develop between underlying lung + cavity
What does it cause?
Pleural cavity perforates. Air into cavity.
Compresses mediastinal structure
Pushes trachea to opposite side.
Symptoms of tension pneumothorax
Signs of pneumothorax
o Pleurtiic chest pain
o Tracheal deviation
o Hyperresonant percussion (like a drum)
o Decr breath sounds because no air going in to lungs
Treating a pneumothorax
Imaging - CT
Treating - needle inserted into intercostal space 2-5th mid-axillary line
Chest drain tube
What are the 2 types of pleural neoplasms
Primary - benign or malignant.
E.g. malignant mesothelioma
Carcinoma, lymphoma, melanoma
What is malignant mesothelioma
Neoplasms of mesothelial cells that lines serous cavities
Can affect Pleura, peritoneum, pericardium, tunica vaginalis
Doesn't spread far
What causes it?
• Thoracic irradiation
• BAP1 mutation (associated with BRCA 1)
• Old people
What does a early tumour cause?
Tumour to difficult to image, so take effusion cytology to i.d. malignant cells
What does a late stage tumour cause
How can it cause infection?
o Obstruction prevents normal clearance of lung
o Pus accumulates
o Infection develops
What are the 3 types of immunostain?
o Cytoplasmic stain forms little ring with pale centres
Wilms tumour antigen
o Nuclei stained
o Tumour in children
o Stains cytoplasm + nuclei
What pleural diseases caused by asbestos?
parietal pleural fibrous plaques – low level asbestos exposure
diffuse pleural fibrosis – splits lung, high level exposure
What lung diseases caused by asbestos?