Pleural and Mediastinal Pathology - Rao Flashcards Preview

M2 Renal/Respiratory > Pleural and Mediastinal Pathology - Rao > Flashcards

Flashcards in Pleural and Mediastinal Pathology - Rao Deck (24)
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What is a pleural effusion?

What volume of fluid defines a pleural effusion?

Describe some processes that cause pleural effusion

Accumulation of fluid in the pleural space

15 mL

Secondary to: increased hydrostatic pressure (CHF, lymphatic blockage), decreased osmotic pressure (nephrotic syndrome), increased vascular permeability (pneumonia)


Describe the clinical manifestations of pleural effusion

dyspnea, pleuritic pain, cough, enlarged hemithorax, dullness on percussion, decreased or absent breath sounds, compression of the lung (atelectasis)


Name (4) systemic conditions that may cause pleural effusion

congestive heart failure


nephrotic syndrome

collagen vascular diseases


What is the treatment of choice for empyema (pyothorax)

Surgical decortication

Organization of the infection and purulent exudate produces adhesions and loculations that limit lung expansion, necessitating surgical removal


Name some underlying conditions leading to hydrothorax

Cardiac failure, pulmonary congestion, edema, cirrhosis, uremia, renal failure


Name some underlying conditions leading to hemothorax

ruptured aortic aneurysm, trauma


Damage to which structure may lead to chylothorax?

What else might cause chylothorax?

Thoracic duct

lymphatic occlusion secondary to malignancy may also lead to chylothorax


Describe the clinical symptoms of pneumothorax

Chest pain, dyspnea

Absent breath sounds on auscultation

hyper-resonant percussion

contralateral deviation of the trachea


marked respiratory distress


Describe the common etiologies of spontaneous pneumothorax

often idiopathic

secondary to rupture of a pleural bleb or bulla (often in a young patient)

Bronchopleural fistula or bullous emphysema


Describe the presenting symptoms and etiology of tension pneumothorax

What is observed on CXR?


sudden onset of respiratory distress secondary to a chest wall defect (penetrating trauma)

Pneumothorax and collapsed lung with trachea deviated to the contralateral side


What is a pleural fibroma? Describe it.

Rare, solitary fibrous tumor of the lung

well circumscribed, polypoid, pedunculated

cured by simple excision

associated with hypoglycemia and clubbing of the fingers


What cell type proliferates in malignant mesothelioma?

What is the most common underlying etiology?



Neoplastic proliferation of mesothelial cells lining the serosal surfaces

Idiopathic or asbestos exposure (~50% each)


Describe the clinical symptoms of mesothelioma

What is the prognosis?

  • insidious, slow-growing neoplasm
  • recurrent pleural effusions
  • chest pain and dyspnea (advanced)
  • pulmonary fibrosis (20%)

Median survival is 18 months


Describe the gross morphological appearance of pleural mesothelioma

Name the two histological subtypes of malignant mesothelioma

Rind of fibrous tissue encasing the entire lung with little-to-no invasion of the parenchyma

Histological: epithelioid type or spindle cell type


What is more common - primary lung malignancy or metastatic tumor?



Name (5) organisms that communly underly granulomatous mediastinitis




atypical mycobacteria



Neurogenic tumors are most commonly found in what part of the mediastinum?



Congenital cysts:

  1. unilocular or multilocular?
  2. patient age range?
  3. contents?

  1. unilocular
  2. children aged 5-15 years
  3. lined with simple cuboidal epithelium and filled with serous fluid


Thymic hyperplasia is commonly associated with what autoimmune disorder?

myasthenia gravis


What is myasthenia gravis?

What are its symptoms?

What mediastinal disorders is it associated with?

Auto-antibodies to the ACh receptors in the neuromuscular junction - due to defective conrontation between ACh-secreting cells with T-lymphocytes in the thymus

Sx: weakness, fatigability, ptosis, diplopia

Associated with: thymic hyperplasia, thymoma, thymic carcinoma


What is a thymoma?

Describe the symptoms

neoplastic proliferation of thymic epithelial cells

usually contains abundant immature T-cells (not part of the tumor)

Frequently associated with myasthenia gravis

slow-growing, rarely metastasizes

Sx: usually asymptomatic, may include cough, dyspnea, chest pain, superior vena cava syndrome, and paraneoplastic syndromes


Describe the cell type found in each of the following histological classifications of thymomas

  • Type A
  • Type B
  • Type AB

  • Type A: spindle cells
  • Type B: round cells
  • Type AB: mixture of both round and spindle cells


Compare the prognosis of encapsulated and non-encapsulated thymomas

encapsulated: cured by complete surgical excision

non-encapsulated: may recur repeatedly and eventually metastasize. Recurrence may lead to thymic carcinoma


Describe the histologic features of thymic carcinoma

No specific or defining features

Closely resembles cell types found in carcinomas of other organs - therefore a diagnosis of exclusion

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