The pleura

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The pleura

  1. 1. THE PLEURAA mesothelial surface lining the lungs and mediastinum Mesothelial cells designed for fluid absorption Hallmark of disease is the pleural effusion
  2. 2. PLEURAL EFFUSIONTransudate (low protein) Exudate (high protein) cardiac failure pneumonia hypoproteinaemia TB connective tissue disease malignancy (primary or metastatic)
  3. 3. PURULENT EFFUSIONFull of acute inflammatory cells Empyema Can become chronic
  4. 4. VARIOUS PATTERNS MAY BE SEEN Serofibrinous pleuritisReflects pulmonary inflamation e.g tuberclosis, pneumonia, infarcts, abcesses or systemic diseases (R.A and uremia) Supparative pleuritis or empyema Reflects pleural space infection leading to pus accumulation Hemorrahgic pleuritis Occurs with bleeding disorders, neoplastic involvment
  5. 5. NON INFLAMMATORY EFFUSIONS Hemothorax(ruptured aortic aneurysm)Chylothorax ( collection of milky lymph) due to neoplastic lymphatic obstruction.
  6. 6. HEMOTHORAX
  7. 7. PNEUMOTHORAX Air in pleural space Trauma Rupture of bulla
  8. 8. PNEUMOTHORAX
  9. 9. LARGE BULLAE
  10. 10. PLEURAL NEOPLASIA Primary benign (rare) malignant mesothelioma Secondarycommon (adenocarcinomas - lung, GIT, ovary)
  11. 11. SOLITARY FIBROUS TUMOR Localized Noninvasive Fibrosing Also occur at other sites Not related to asbestose Resection is usually curative
  12. 12. MALIGNANT MESOTHELIOMAAssociated with asbestose exposure in 90% cases only 20% have pulmonary asbestosis
  13. 13. CLINICAL FEATURES Pts present with chest pain, dyspnea and recurrent pleural effusionsHighly malignant tumors that invade the lung and can metastasize widely. Fewer pts survive longer than 2yrs.
  14. 14. MESOTHELIOMAhttp://www.mesothelioma.com/images/pleural-mesothelioma.jpg
  15. 15. PLEURAL BIOPSY - MESOTHELIOMA Mixed spindle cell(mesenchymal) and epithelial differentiation
  16. 16. METASTASES IN PLEURA
  17. 17. DIFFERENTIAL DIAGNOSIS OF MALIGNANT EFFUSIONS Cytology, biopsy Difficult to diagnose Immunohistochemistry for lineage specific antigens may help Medicolegal importance
  18. 18. REFFERENCEShttp://www.mesothelioma.com/images/pleural-mesothelioma.jpghttp://www.mdguidelines.com/empyema/definitionhttp://treatment-zone.blogspot.comhttp://www.medicinenet.com/imagecollection/pneumothorax_picture/picture.htm

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