This document provides an overview of pleural effusion, including:
- Pleural effusion is abnormal fluid accumulation in the pleural space between the lungs and chest wall. Fluid builds up due to changes in pressure or permeability.
- Effusions are classified as transudative or exudative based on their mechanism and composition. Causes include infections, cancers, heart failure, and other conditions.
- Symptoms depend on the underlying cause but may include chest pain, difficulty breathing, and cough. Diagnosis involves physical exam, imaging like x-rays, and analyzing pleural fluid obtained via thoracentesis.
- Management consists of treating the underlying condition medically or surgically with drainage
Abnormal fluid accumulation in potential space in between parietal and visceral pleurae – there is imbalance between formation and absorption in response to injury, inflammation or both locally and systematically
Apparently a lengthy presentation actually very good for junior physicians as it covers all aspects of assessment, diagnosis and treatment of pleural effusion
Pleural effusion may be defined figuratively as the juice, oozing from the leaky lingerie of the lung. However the text book definition is the abnormal accumulation of fluid in the pleural space due to disturbances in the forces that keep the pleural fluid economy in equilibrium...
Abnormal fluid accumulation in potential space in between parietal and visceral pleurae – there is imbalance between formation and absorption in response to injury, inflammation or both locally and systematically
Apparently a lengthy presentation actually very good for junior physicians as it covers all aspects of assessment, diagnosis and treatment of pleural effusion
Pleural effusion may be defined figuratively as the juice, oozing from the leaky lingerie of the lung. However the text book definition is the abnormal accumulation of fluid in the pleural space due to disturbances in the forces that keep the pleural fluid economy in equilibrium...
lupus nephritis is a autoimmune disease, commonly seen in adult and child and the medical or nursing care is also very important for this type of disease condition.
What is bronchiolitis and its definition, the age group, signs and symptoms and clinical presentation The clinical practice guidelines, how to diagnosis, clinical criteria, what are the severity degrees and How to assess the severity, what are the investigations that may be needed, Is there any diagnostic test, what is the prognosis
What is the management,
Pneumonia is an inflammatory condition of the lung affecting primarily the small air sacs known as alveoli. Typically symptoms include some combination of productive or dry cough, chest pain, fever, and trouble breathing. Severity is variable.
Pneumonia is usually caused by infection with viruses or bacteria and less commonly by other microorganisms, certain medications and conditions such as autoimmune diseases. Risk factors include cystic fibrosis, chronic obstructive pulmonary disease (COPD), asthma, diabetes, heart failure, a history of smoking, a poor ability to cough such as following a stroke, and a weak immune system. Diagnosis is often based on the symptoms and physical examination. Chest X-ray, blood tests, and culture of the sputum may help confirm the diagnosis. The disease may be classified by where it was acquired with community, hospital, or health care associated pneumonia.
Vaccines to prevent certain types of pneumonia are available. Other methods of prevention include handwashing and not smoking. Treatment depends on the underlying cause. Pneumonia believed to be due to bacteria is treated with antibiotics. If the pneumonia is severe, the affected person is generally hospitalized. Oxygen therapy may be used if oxygen levels are low.
Pneumonia affects approximately 450 million people globally (7% of the population) and results in about four million deaths per year. Pneumonia was regarded by William Osler in the 19th century as "the captain of the men of death". With the introduction of antibiotics and vaccines in the 20th century, survival improved. Nevertheless, in developing countries, and among the very old, the very young, and the chronically ill, pneumonia remains a leading cause of death. Pneumonia often shortens suffering among those already close to death and has thus been called "the old man's friend"
Seminar present the Upper Gastrointestinal Bleeding problems
Edited by : Dr. Inzar Yassen & Dr. Ammar L. Aldwaf
in Hawler Medical Uni. collage of medicine in 14/01/2014
Iraq - Kurdistan - Erbil
lupus nephritis is a autoimmune disease, commonly seen in adult and child and the medical or nursing care is also very important for this type of disease condition.
What is bronchiolitis and its definition, the age group, signs and symptoms and clinical presentation The clinical practice guidelines, how to diagnosis, clinical criteria, what are the severity degrees and How to assess the severity, what are the investigations that may be needed, Is there any diagnostic test, what is the prognosis
What is the management,
Pneumonia is an inflammatory condition of the lung affecting primarily the small air sacs known as alveoli. Typically symptoms include some combination of productive or dry cough, chest pain, fever, and trouble breathing. Severity is variable.
Pneumonia is usually caused by infection with viruses or bacteria and less commonly by other microorganisms, certain medications and conditions such as autoimmune diseases. Risk factors include cystic fibrosis, chronic obstructive pulmonary disease (COPD), asthma, diabetes, heart failure, a history of smoking, a poor ability to cough such as following a stroke, and a weak immune system. Diagnosis is often based on the symptoms and physical examination. Chest X-ray, blood tests, and culture of the sputum may help confirm the diagnosis. The disease may be classified by where it was acquired with community, hospital, or health care associated pneumonia.
Vaccines to prevent certain types of pneumonia are available. Other methods of prevention include handwashing and not smoking. Treatment depends on the underlying cause. Pneumonia believed to be due to bacteria is treated with antibiotics. If the pneumonia is severe, the affected person is generally hospitalized. Oxygen therapy may be used if oxygen levels are low.
Pneumonia affects approximately 450 million people globally (7% of the population) and results in about four million deaths per year. Pneumonia was regarded by William Osler in the 19th century as "the captain of the men of death". With the introduction of antibiotics and vaccines in the 20th century, survival improved. Nevertheless, in developing countries, and among the very old, the very young, and the chronically ill, pneumonia remains a leading cause of death. Pneumonia often shortens suffering among those already close to death and has thus been called "the old man's friend"
Seminar present the Upper Gastrointestinal Bleeding problems
Edited by : Dr. Inzar Yassen & Dr. Ammar L. Aldwaf
in Hawler Medical Uni. collage of medicine in 14/01/2014
Iraq - Kurdistan - Erbil
Pulmonary manifestations of systemic diseases (non CTD)Sesha Sai
Pulmonary manifestations of systemic diseases other than connective tissue disorders like stem cell, endocrine, abdominal, neuromuscular, hematological, chest wall abnormalities
What is swine flu?How swine flu presents?How to diagnose swine flu?How to treat swine flu? What are the vaccines for swine flu?How to prevent from getting swine flu?
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Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
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The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
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Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
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2 Case Reports of Gastric Ultrasound
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
3. • Pleural effusion is defined as abnormal
accumulation of fluid in the pleural
space, i.e., the space between parietal
and visceral pleura
• The pleural space contains normally
0.3ml/kg body weight of pleural
fluid1. There is a continuous circulation
of this fluid and the lymphatic vessels
can cope with several millilitres of extra
fluid per 24hours
• Fluid accumulates in the pleural cavity
due to either altered hydrostatic and
oncotic pressures or altered
permeability of the pleura
Introduction
4. More Definitions ?
• Parapneumonic Effusion : pleural effusion associated
with bacterial pneumonia, bronchiectasis, or lung
abscess .
• Loculated Effusion : Fluid anatomically confined and
not freely flowing in the pleural space when there are
adhesions between the visceral and the parietal
pleura .
• Sub-Pulmonic Effusion:accumulation of fluid between
the lung & the diaphragm which gives the false
impression of an elevated hemi-diaphragm
7. •Can be unilateral or bilateral and classified
A)Based on site
Apical
Interlobar
Sub-pulmonic
Mediastinal
B)Based on mechanism and type of pleural fluid
Transudative (alteration in hydrostatic and oncotic pressure)
Exudative (alteration in pleural permeability)
Classification
8. c) Based on mechanism and type of pleural fluid
formed
Pyogenic
Chylous
Haemothorax
Pseudochylous
Hydrothorax
Urinothorax
9. Transudative pleural effusions
Alteration of hydrostatic and oncotic factors
that increase the formation or decrease the
absorption of pleural fluid (e.g., increased
mean capillary pressure [heart failure] or
decreased oncotic pressure [cirrhosis or
nephrotic syndrome]).
10. Exudative pleural effusions
Damage or disruption of the normal pleural
membranes or vasculature (e.g., tumor
involvement of the pleural space, infection,
inflammatory conditions, or trauma) leads
to increased capillary permeability or
decreased lymphatic drainage.
11. Pathogenesis
• Increased vascular permeability allows migration of
inflammatory cells (neutrophils, lymphocytes, and eosinophils)
into the pleural space.
• The process is mediated by a number of cytokines such as
interleukin IL-1, IL-6, IL-8, tumour necrosis factor (TNF)-alpha and
platelet activating factor released by mesothelial cells lining the
pleural space. The result is the exudative stage of a pleural
effusion. This progresses to the fibro-purulent stage due to
increased fluid accumulation and bacterial invasion across the
damaged epithelium.
• Neutrophil migration occurs as well as activation of the
coagulation cascade leading to pro-coagulant activity and
decreased fibrinolysis. Deposition of fibrin in the pleural
space then leads to septation or loculation. The pleural
fluid pH and glucose level falls while LDH levels increase.
18. Clinical Presentation
The underlying cause of the effusion usually
dictates the symptoms, although patients may be
asymptomatic.
Pleural inflammation, abnormal pulmonary
mechanics, and worsened alveolar gas
exchange produce symptoms and signs of
disease.
19. Symptomsand signs
Inflammation of the parietal pleura leads to
pain in local (intercostal) involved areas or
referred (phrenic) distributions (shoulder).
Dyspnea is frequent and may be present
and out of proportion to the size of the
effusion.
Cough can occur.
20. Physical examination
Inspection:
Absent or diminished movements of affected side
Fullness of chest with bulging intercostal spaces
Palpation:
Diminished breath sounds over the site of the effusion
Decreased or absent tactile fremitus
Percussion:
Stony dullness to percussion
Auscultation:
Absence of breath sounds over the effusion
Vocal resonance absent
Signs of pneumonia like bronchial breathing, crackles etc.
21. Investigations
Total and differential leucocyte counts
• Acute phase reactants-white cell count, total neutrophil
count, CRP, ESR, pro-calcitonin distinguish bacterial from
viral causes
Radiological examination
• X-ray chest PA view done in erect position-a total of
300mL of fluid is needed to diagnose pleural effusion
clinically and radiologically
• Even 50mL of fluid can be demonstrated radiologically in
lateral decubitus
22. Findings
• Obliteration of cardiophrenic and costophrenic angles
• Loculated effusions
• Subpulmonic effusion-collection of fluid below the
diaphragm will lead to elevation of diaphragm, confirmed
by X-ray in lateral decubitus
• Lateral decubitus on side of effusion will show a shift in
the fluid level
• Tracheal and mediastinal shifts are seen in massive
effusion
23.
24. Ultrasonogram
Useful in differentiating between loculated pleural effusion and tumour
CT Scan
Helpful if the effusion is minimal or loculated
Pleural fluid aspiration (Thoracocentesis)
Diagnostic: Helps to differentiate between exudates and transudates
Therapeutic: Massive collection or rapid collection of pleural fluid
Severe respiratory distress
Suspected empyema
Massive mediastinal shift
27. LIGHT’S CRITERIA:
• Atleast one of the following criteria should be
satisfied to identify exudates:
Pleural fluid to serum total protein ratio- more than
0.5
Pleural fluid to serum LDH ratio- more than 0.6
Pleural fluid LDH- more than two-third of serum LDH
None of these criteria should be satisfied in a
transudative effusion
28. Pleural fluid appearance
• Most transudates are clear, straw colored,
nonviscid, and without odor
• Red-tinged pleural effusions indicate the
presence of blood.
29. Bloody pleural fluid
• If the blood is due to thoracentesis, the degree of
discoloration should clear during the aspiration.
• Bloody pleural fluid usually indicates the
presence of malignancy, pulmonary embolism
(PE), or trauma.
30. Hemothorax
• The presence of gross blood should lead to
the measurement of a pleural fluid
hematocrit.
• Hemothorax is defined as a pleural fluid to
blood hematocrit ratio of >0.5, and chest tube
drainage should be considered.
31. Eosinophilia (>10% of total nucleated cell count) is
suggestive of air or blood in the pleural space. If
air or blood is not present in the pleural space,
consideration should be given to fungal and
parasitic infection, drug- induced disease, PE,
asbestos-related disease, and Churg-Strauss
syndrome.
32. • Lymphocytosis (>50% of the total nucleated
cell count) is suggestive of malignancy or
tuberculosis.
• Mesothelial cells argues against the
diagnosis of tuberculosis.
• Plasma cells suggest a diagnosis of multiple
myeloma.
33. Glucose concentration
A glucose concentration of <60 mg/dL is
probably due to
tuberculosis,
malignancy,
rheumatoid arthritis, or
parapneumonic effusion.
For parapneumonic pleural effusions with a
glucose of <60 mg/dL, tube thoracostomy
should be considered.
34. Pleural fluid with a low pH
A pH of <7.3 is seen with
• empyema,
• tuberculosis,
• malignancy,
• collagen vascular
disease, or
• esophageal rupture.
35. Amylase
• An elevation of amylase suggests that the
patient has pancreatic disease, malignancy,
or esophageal rupture.
• Malignancy and esophageal rupture have
salivary amylase elevations and not
pancreatic amylase elevations.
36. Turbid or milky fluid
After it is centrifuged.
• If the supernatant clears, the cloudiness is likely due to
cells and debris.
• If the supernatant remains turbid, pleural lipids should be
measured. Elevation of triglycerides (>110 mg/dL)
suggests that a chylothorax is present, usually due to
disruption of the thoracic duct from trauma, surgery, or
malignancy (i.e., lymphoma).
37. Cytology
Cytology is positive in approximately 60% of
malignant effusions.
The volume of pleural fluid analyzed does not
impact the yield of cytologic diagnosis.
Repeat thoracentesis increases the
diagnostic yield.
38. Urinothorax
Due to obstructive uropathy
Urine arrives in the pleural space either
retroperitoneally under the posterior
diaphragm, or via the retroperitoneal
lymphatics
Pleural fluid smells of urine.
Pleural fluid Creatinine ≈ Serum Creatinine
40. Pleural Biopsy
• Can be done at maximum dullness on percussion or
at a maximum thickening of pleura. Abram’s pleural
biopsy needle is used for biopsy
• Most helpful in evaluating for TB
• Limited utility for CA (40-50% positive)
Repeat cytology x 3
• Sarcoid, fungal: might be helpful
41. Management
SUPPORTIVE TREATMENT
• Oxygen is necessary if SpO2 <92%
• Fluid therapy if child dehydrated or unable/unwilling
in drinking water
• Initiate IV antibiotics
• Analgesics and antipyretics
• Chest radiography & U/S
42. Medical
• Treat the cause
Pneumonia- initial antibiotic treatment
A) Following community acquired pneumonia
• Cefuroxime
• Co-amoxiclav
• Penicillin & flucloxacillin
• Amoxicillin & flucloxaxillin
• Clindamycin
B) Hospital acquired pneumonia
• Broader spectrum antibiotics that cover aerobic gram negative rods
43. • Tuberculosis- Category I treatment
2HRZE+4HRE
Prednisolone 1-2mg/kg orally 4-6weeks promotes
rapid absorption of the pleural fluid and prevents
fibrosis
• Congestive cardiac failure- treat with diuretics and
other anti-failure medications
44. Surgical
• Pleural fluid aspiration is done by using a wide bore
needle. If the fluid is thick and cannot be drained by a
needle, an intercostal drainage(under water seal) at the
most dependant part should be done.
45. Tube Thoracostomy
•Pneumothorax
•Pleural fluid loculated
•Recurrent Pleural effusion - malignancy
•Effusion filling more than half the hemithorax
•Air fluid level – Hydro/Pyopneumothorax
•Pus in the pleural space - Empyema
•Hemothorax/Chylothorax
•Para pneumonic effusion
oPositive stain for microorganisms
oPositive pleural fluid cultures
oPleural fluid pH <7.2
oPleural fluid glucose <60 mg/dL
46. Underwater seal bag is used as one way valve mechanism.
The air or fluid/pus from the pleura enters the underwater
drainage bag, but the atmospheric air cannot enter pleura due
to under water seal
47.
48.
49. Failure to drain with a single small-bore tube
should also lead to thoracic surgery consultation to
avoid delays in case video assisted thoracoscopy
(VATS) becomes necessary.
VATS
50. Chemical pleurodesis
Chemical pleurodesis is an effective therapy for
recurrent effusions. This treatment is recommended
in patients whose symptoms are relieved with initial
drainage but who have rapid reaccumulation of fluid.
Talc slurry - Effective and inexpensive.
Doxycycline or minocycline can also be instilled
into the pleural space via a chest tube.
Pain is more prevalent and severe following
doxycycline and minocycline than following talc.
51. Chronic indwelling pleural catheters
Provide good
control of
effusion-related
symptoms via
intermittent
drainage.