Presentation done by a medical student

1. Pleurisy
Koumail Yassine
Group 8
4th dozen

2. Physiology of the Normal
Lungs
• The lungs are soft, spongy, cone-shaped
organs located in the chest cavity.
• They are Separated by the mediastinum
and the heart. There are 3 lobes on the
right lung and 2 lobes on the left lung.

3. Layers of the lung pleura
• Parietal Pleura -Lines the thoracic
cavity, including the thoracic cage,
mediastinum, and diaphragm.
• Pleural Space- thin, transparent,
serous membrane which lines the
thoracic cavity a potential space
between the parietal pleura and
• Visceral pleura- Lines the entire
surface of the lung.

4. Normal vs impaired physiology
• The body produces pleural fluid in small amounts to lubricate the
surfaces of the pleura, it lines the chest cavity and surrounds the
lungs. The pleural cavity contains a relatively small amount of fluid,
approximately 10 ml on each side
• A pleural effusion is an abnormal, excessive collection of this fluid .
• Excessive amounts of such fluid can impair breathing by limiting the
expansion of the lungs during inspiration causing a stabbing pain in
the chest.
• This is pleurisy!

5. Syndromes Associated
with Pleurisy

6. The syndrome of accumulation of fluid in the
pleural cavity
• severity of symptoms depends on the amount of exudate!
• bulging of intercostal spaces behind the affected side during dynamic
examination
• reduced of the mobility of the lower pulmonary region on the affected
side
• changed borders of the relative cardiac dullness
• the lack of voice tremor above the accumulation of fluid;
• dullness over the place of accumulation of fluid
• vesicular breathing does not auscultate
• bronchophony is weakened

7. Radiological findings
blunting of the costophrenic angle
blunting of the cardiophrenic angle
fluid within the horizontal or oblique fissures

8. Other scans
Ultrasound: is useful both as a
diagnostic tool and as an aid in
performing thoracentesis. It assists
in identifying pleural fluid locations.
CT-scan: t helps distinguish
anatomic compartment more
clearly. This modality is useful as
well in distinguishing empyema

9. Pain syndrome
• complaints of pain in the chest
• knife-stabbing pain- forced position of the body
• tenderness (painful palpation of thorax).

10. Other syndromes
Syndrome of local inflammation: cough with phlegm (mucus or
muco purulent);
Syndrome of general inflammation: - fever (and the associated with
it complaints of a general nature); - changes in the blood count
( leukocytosis, accelerated erythrocyte sedimentation rate).
Respiratory failure syndrome: - shortness of breath; - cyanosis; -
tachypnea; - decrease in the partial pressure of oxygen; - decrease
in oxygen saturation.

11. Classification and
Diagnosis

12. Dry vs Wet pleurisy
• Wet: increased pleural fluid which
compresses the lung
• Dry: decreased pleural fluid to the
point where the layers rub
together

13. Transudative vs Exudative pleural effusion

15. Differential
Diagnosis
Transudative
vs exudative

16. On Type of Exudate
• Serous and serofibrinous pleurisy (tuberculosis in 70 to 90 percent of
cases, pneumonia, certain infections, and also rheumatism in 10 to 30
percent of cases)
• Purulent process (pneumococci, streptococci, staphylococci, and
other microbes)
• Hemorrhagic pleurisy (tuberculosis of the pleura, bronchogenic
cancer of the lung with involvement of the pleura, and also in injuries
to the chest

17. Pleural fluid indications

18. Treatment

19. • treatment aims to: 1) Remove the fluid and prevent fluid from building up again, and
2) Treating the cause of the fluid buildup
• Therapeutic thoracentesis: may be done if the fluid collection is large and causing
chest pressure, shortness of breath, or other breathing problems, such as low oxygen
level. Removing the fluid allows the lung to expand, making breathing easier
• pleural effusions caused by congestive heart failure are treated with diuretics and
other medication that treat heart failure
• Pleural effusions caused by infection are treated with appropriate antibiotics after
Gram stain and culture to identify possible bacterial infections
• Cytopathology to identify cancer cell, and Treat accordingly.

20. Possible
complications
More often pleurisy is itself the complication
of another pathologic process
Pleural fluid that becomes infected may turn
into an abscess, called an empyema, which
will need to be drained with a chest tube
Pneumothorax (air in the chest cavity) can be
a complication of the thoracentesis
procedure

21. References
• a Putnam 8. Malignant pleural effusions. Surg Clin NAm.2OO2;38375-
383.
• B. Víllena v, López Encuentra E, García-Luján R, Clinical implications of
appearance of pleural fluid at thoracentesis.Chest.2OO4;I25:I56-9.
• D. villena garrido v et al. diagnosis and treatment of pleural
effusion(2oo5}

22. Thank You